Report of the IMTF's study at ANEC, Cairo, October 2008
We would like to take this opportunity to thank you for completing the International Malnutrition Task Force (IMTF) survey during the third ANEC at Cairo, Egypt, 2008.
Attached please find the report.
The issues raised during the study especially regarding bottlenecks to effective management of SAM children and suggested solutions would be discussed one at a time but for now we would like you to comment on the general report by clicking on 'comments' below.
Focusing on SAM is a good idea to try and save lives and provide hope. I agree however with Dr Folake Samuel that SAM is the tip of the iceberg and I want to believe that for every case of SAM seen at a health centre or clinic, there are at least 9 children with at least moderate malnutrition out there who may not be captured. These 'veterans' of the early manutrition wars in my view, may bearly continue to manage and enter their school years with both overt signs of growth failure and sub-clinical and chronic micronutrient deficiencies. These are the ones who will not perform well at school because of the continuing effects of malnutrition.
I believe MDG 1 (targeting chronic poverty), MDG 4 (reducing under 5 mortality), MDG 5 (targeting maternal health) and MDG 6 (dealing with infectious co-morbidities need to be tackled together with SAM treatment. I would like to see integrated health systems harnessing local agriculutre and food sources alongside nutrition and health education, water systems management and school based agriculture to provide sustainable food-based solutions along the life cycle.
I am also of the opinion that tackling the problem should be multi-dimentional and should involve several sectors. Training in SAM treatment should include public health practitioners (especially nurses and medical assistants working at health centres, other allied health workers) as well as clinicians and clinical nurses. I would also suggest involvement of hospital dieticians and training of nutrition students in clinical management of SAM and other forms of malnutrition as part of the health team.
I have recently held discussions with colleagues in Africa who have confirmed that they see more cases of moderate and mild manutrition than SAM and that many of these patients die of complications of other co-morbidities. I would like to see a success of the IMTFs work and for it to be sustained. The latter can only come about through local capacity building, local involvement and supportive programmes (including school based agriculture/farming) which reduce household food poverty and provide hope.
I would also like to see partnerships based on good needs assessments and encouraging particularly the medical porofession to work with others as equals in a concerted and genuine effort to tackle childhood malnutrition and reduce child mortality, morbidity and risk of long term chronic disease.
Comment by Paul Amuna — 2009-02-24 15:27 | # - re
I wish to Highlight Paul’s last paragraph. I strongly agree with him, we are in a stage where we need to put hands on: organize our thoughts, set up priorities, get together and work holding our hands. At this point, all countries have a health system in place, regulated by the governments, certainly with a lot of problems but that is another reason to work harder. We have as well a wide range of international organizations working on nutrition in most countries, both supporting the governments or working on direct interventions. And finally we have the Nutritionists, and all of those from the civil society that might be interested in moving the nutrition agenda, especially on SAM, forward.
We often wait to see what our governments or international organizations will do. But then, as it has been already said many times, we also need to do something.
-What will we do to make those same organizations accountable for regarding SAM? -How will we get involved in each of our country’s process and simultaneously work together? -How can we form an active and effective network of Nutritionist that could serve as catalyst to move the agenda on SAM and nutrition in general forward? -Can the IMTF serve as focal point to start building such network? -What kind of resources and support systems will we need to put in place to make it happen?
Let’s continue this process that we have already started by putting on the table concrete and realistic ideas, and gradually implement them.
Comment by Daniel Gallego — 2009-01-28 06:22 | # - re
The problem of SAM in children is just the tip of the iceberg but, nevertheless, an important one. In fact the issue of SAM, which is a big fish on the IMTF’s plate, is just to kick-start what, I believe, would galvanise all concerned African nutritionists to see the need to forge a common purpose to tackle the issue of malnutrition in Africa.
The focus of the study was mainly on HEALTH PROFESSIONALS in close contact with the prevention, treatment and management of SAM. In Africa when mention is made of health professionals a certain group of persons are given first place, and in most cases ‘nutritionists’ do not make the list. This may call for a redefinition of who a nutritionist is. The point made by Samuel Folake that ….. many of us nutritionists are not directly involved, and are not frequently involved with SAM cases. This is because we are in the universities, not hospitals or community health posts…. raises a lot of questions about the way nutritionists perceive themselves or are perceived by others.
Are nutritionists also health professionals? I think they are, and a lot of people would agree with me on this (This can be a long but unnecessary debate). However, I also think that, most nutritionists (especially those who are poised to fight the African cause) must redefine their attitudes and reform their ways of thinking with regards to who they really are, and what they must be doing where ever they find themselves. Because we are often not considered health professionals we do no avail ourselves to knowledge and build our capacities in aspect considered traditionally health related (I may be wrong here). Our attitude towards all aspects of policies, especially those that impinge on our work, leaves so much to be desired.
For those of us who are responsible for training the ‘new breed’ of nutritionists (including those with interest in nutrition) I think this is a very big challenge. We need to reconsider the way we train nutrition health professionals taking into consideration the outcomes of this report. I do not know as yet how many of those who know or heard about the WHO’s 10 steps as well as those who have a knowledge of their countries policies are nutritionists or have an interest in nutrition. I am sure your guess would be as good as mine.
I personally think that the stage for coming together and forging a common goal is set by the different fora we are privileged to be presented with – conferences, seminars, networks, etc. Let us make the best of every opportunity to translate these experiences into actions that would not only help alleviate or eradicate SAM from our beloved continent but would put nutrition in its rightful place in the development agenda.
Comment by Paul Aryee — 2009-01-27 15:58 | # - re
Two issues struck me in the report: First of all, It appears that more poeple were aware of the WHO ten-steps to manage SAM, than of their national policies for managing, preventing and/or controlling of SAM.Is this an indication that there are no national policies, or a sign of poor dissemination?
Secondly, I agree that in Africa we should do more to reach doctors, nurses and other health workers, since a larger number of them come in direct contact with SAM than nutritionists. One major challenge I see in my country is that many of us nutritionists are not directly involved, and are not frequently invloved with SAM cases. This is because we are in the universities, not hospitals or community health posts. However, with the availability of technology such as the internet which is able to reach out to many people, the news will go round soon and reach many of those who are directly invloved.
Comment by Folake Samuel — 2009-01-23 00:06 | # - re
I was in Egypt and was one of those who completed the questionnaires from IMTF on SAM. I am happy that it was not a waste of time completing the questionnaire because the report came out in good time. Most times you complete such questionnaires and dont even hear of any report.
I think the report has brought out very important issues that need attention at different levels. The bottlenecks identified in the report are very real. It is only instructive that we begin to discuss issues arising from the report. I have noticed (probably wrongly) that our focus/attention for action, as far as SAM is concerned, is on professionals in the field. This is not to falter our focus, but I think that as we move forward we try to identify interventions that could introduce the management of SAM to students under training. This will be an area some of us would be interested in since we are in the classroom. Once again thumbs up for you for starting the process.
Comment by Abizari Abdul_Razak — 2009-01-22 23:15 | # - re
I didn't attend the conference unfortunately . However, this survey initiative is a nice one. Regarding SAM, I should say it is not only sufficient to educate communities but when we are talking about education, we should stress on the importance to send people to school because from my own experience in dealing with nutrition in africa, education, at least basic education are of high importance to change minds and deliver people from cultural attitudes that resist behavioural changes. Also , since the CTC approach brings new cut offs for admission and release from stabilization centers (former TFC's), those cut offs should be also reviewed in international guidelines like SPHERE guidelines. My final point is even though we are talking about SAM, we should not forget that aroung 80% of deaths are due to moderate malnutrition.
Comment by Etel Godwill — 2009-01-17 20:43 | # - re
I think this survey was an interesting instrument to measure nutrition professionals’ perceptions about several aspects of SAM. I assume most people that answered it were (at least) interested in the topic since (if I remember well) most of questionnaires were distributed during the “Management of Malnutrition and Nutritional Support in Developing Countries” Symposiums at ANEC.
There are several interesting figures that could help us to put things together.
Since we have the nationalities of the respondents it would be interesting to do some cross matching of variables. 2/3 of the participants were from Africa, and similarly 2/3 the total thought that malnutrition was a problem in their home countries. I would guess at first glance that those thinking that malnutrition was a problem were coming from Africa, but it might be different.... Other cross matching that I would like to see is whether those that reported to be working with children with SAM knew all about the WHO’s 10 steps for the management of SAM or in which proportion some didn’t (just to be sure).
2/3 of the participants are not aware or don’t know of the existence of national policies on SAM, which is a very interesting indicator... sometimes we focus way too much on our clinical and scientific work and we leave equally important aspects of it as the policy ones, behind... shouldn’t we, as civil society, participate as guardians of our fellow citizens and try to make efforts to know where our governments and communities stand and what is the legal framework (with all its implications) of our work? But please don’t ask me if I know about mine...!
It seems like the vast majority of us agree that there are bottlenecks for implementing policies and international guidelines more widely and rigorously (for the benefit of those that need proven strategies be on place). And equally so, it seems like there are consensus on what is important to be done. And, when looking at those strategies and tools, are they beyond our capacity and range of action? My first thought would be that they are not. That perhaps all what we need is more organization, sharing of ideas, networking, mobilization of resources (than often happens when everything is into place), and commitment.
It sounds realistic to me that we can take the lead in doing advocacy, formulating/advising on policies, perform capacity building at different levels, create partnerships (which was a recurrent topic in ANEC) and collaborate with other stakeholders; as well as to participate in education and information dissemination to the general public. And again, as citizens we should participate in the monitoring and evaluation of the problems of our communities and countries.
If 64% of us think that there is not training available on SAM shouldn’t we organize ourselves and find possible solutions? Many of us are those that are going to do those trainings anyways, and maybe we should not wait until we are called upon.
If most of us have some many ideas and over 80% of us think that a web-based platform could be an interesting tool to move the agenda on SAM forward (which would have the greater impact that we all are aware of), then let’s start to build step by step a more organized network where we can support each other to achieve better results.
Comment by Daniel Gallego — 2009-01-16 15:18 | # - re
There are a lot of implications for the outcomes from this report. However, the general overview is that, the problem of SAM is quite real and highly recognised by ourselves. There is obviously a need to act, and much as all stake holders must be involved, it is my humble opinion that nutritionists (including those with a primary interest in nutrition) must take a centre stage and be prepared to make the difference.
Comment by Paul Aryee — 2009-01-12 11:13 | # - re
I think the report generally is a reflection of what is happening and the bottlenecks mentioned are real. I think there is the need for improved support systems for both facility and community-based management of SAM. I also believe that a web-based support can contribute a great deal. However issues surrounding poor access to internet especially in poor rural communities where some health staff work should be addressed.
Comment by reggie — 2008-12-08 13:32 | # - re