Malnourished children, particularly those with severe acute malnutrition, have a higher risk of death from common childhood illness such as diarrhea, pneumonia, and malaria. Malnutrition and malaria combine in a vicious circle that has a huge impact on morbidity and mortality among the most vulnerable in the population (children and pregnant women). To tackle these challenges, it is imperative that stakeholders in global health align their efforts and adopt an integrated approach to achieve maximum impact and save the most lives.
On August 23, 2017, the Corporate Alliance on Malaria in Africa (CAMA) convened a group of experts to discuss an integrated delivery approach to addressing malaria and undernutrition particularly amongst children under-five and women of reproductive age.
For webinar video and audio click here.
To download the presentation click here.
Ms. Ochuko Keyamo-Onyige, Nigeria Country Manager, CAMA Lead
Dr. Peter Olumese Medical Officer, Prevention Diagnosis and Treatment, Global Malaria Programme, World Health Organization
Dr. Kolawole Maxwell, Nigeria Country Director, Malaria Consortium
Dr. Francis Aminu Director, Health and Nutrition, Dangote Foundation
Ms. Ochuko Keyamo
- Welcomed the speakers and the participants to the meeting by providing an overview of the work of the Corporate Alliance on Malaria in Africa (CAMA).
- CAMA is a platform for companies to come together, learn from each other and forge lasting and impactful partnerships for malaria control and elimination.
- CAMA has done a deep dive in Nigeria over the last few years and has published a report on that work. It can be found here.
Dr. Peter Olumese (WHO)
- Peter began his presentation by providing background on the burden of malaria and nutrition as key public health challenges particularly amongst pediatric populations. He gave the statistic: Malnutrition is the underlying cause of death in 50% of childhood deaths in developing countries despite not always being registered as such.
- Peter emphasized that malnutrition and infection operate synergistically. They have similar target populations, similar seasonality and similar mechanisms for delivery of services creating a clear opportunity for an integrated response.
- He went on to highlight the clear links between seasonal malaria chemoprevention (SMC) and nutrition programs emphasizing the high burden of both diseases particularly in West and Central Africa.
- Key opportunities for integration include:
- Nutrition screening and referral of identified cases of acute malnutrition as a part of SMC outreach;
- Direct provision of food supplements; and
- Integration of behavior change communication to mothers to improve rates of early and exclusive breastfeeding.
- Peter went on to outline certain programmatic considerations for integrating various programs with SMC. These considerations along with a list of advantages and challenges to integration can be found on slides 12-16 in the presentation.
Dr. Kolawole Maxwell (Malaria Consortium)
- Maxwell provided an overview of Malaria Consortium’s experience integrating nutrition into existing iCCM programs in South Sudan and Northern Nigeria.
- Maxwell importantly provided a definition for integration from the WHO to help guide our understanding: “The organization and management of health services so that people get the care they need, when they need it, in ways that are user friendly, achieve the desired results and provide value for money.” He also emphasized that integrating health programs is a continuum and new interventions be introduced gradually. All at once integration doesn’t necessarily improve outcomes as programs should be tailored for different levels of care and must result in better value for money.
- Maxwell discussed in detail the program in South Sudan describing the specific health activities at the community level that allowed for an integrated malaria, diarrhea, pneumonia and nutrition program to succeed in a highly volatile setting. Over three years, admissions for all illnesses increased by 35% and treatment of acute malnutrition increased by 33%.
- Key findings from the work:
- iCCM + nutrition has resulted in improved delivery and increased coverage of nutrition services
- The referral of children to OTPs strategically located in the community has resulted in higher recovery rates of those admitted with severe acute malnutrition
- Lessons learned to date:
- Strengthen the connection between iCCM and nutrition
- Improve training and supervision of field staff
- Follow up after referrals
- Maxwell concluded his presentation by outlining the RISE Project in Nigeria and the current pilot for including nutrition screening and services. For more information please refer to slides 32-33 in the presentation.
Dr. Francis Aminu (Aliko Dangote Foundation)
- Francis gave an overview of the Foundation’s Integrated Nutrition Programme (ADFIN) providing a clear rationale for the focus on Northern Nigeria as a starting place – with 47.4% and 30.8% of children underweight in the North West and North East respectively.
- Francis presented a comprehensive graphic (found on slide 45) of the multidimensional causes of childhood malnutrition including infection, maternal and child care practices and poverty – among others.
- ADF views the individual patient’s nutritional status as a window into the nature of the challenges faced by his/her household.
- Francis then outlined in detail the ADFIN program with five key goals
- Treat at least 1,000,000 children with SAM using a CMAM approach by 2025;
- Reach 1,000,000 vulnerable households from communities that contribute the most to the SAM burden with engendered optimal nutrition, hygiene and care-seeking behaviours by 2025;
- Reach 1,000,000 vulnerable households from communities that contribute the most to the SAM burden with improved food security and livelihoods, especially among women, that increase access to a diverse nutritious diet by 2025;
- Improve federal, state and local government capacity to deliver nutrition interventions through advocacy and coordination; and
- Improve capacity at community level to deliver nutrition interventions through empowerment and participation.
- Francis then provided two slides (49-50) on the process and intervention approach ADF is planning to take as they embark on this ambitious project – opening the call to implementing and supportive partners focused on Northern Nigeria to join their work.
The Q&A session can be viewed on the linked video beginning at 58:20.
Ms. Ochuko Keyamo-Onyige
As Nigeria Country Manager, Ochuko leads the expansion of the Corporate Alliance on Malaria in Africa (CAMA) into the Nigerian, and broader West African market. She executes on all program strategy and activities, including management of an Annual Malaria Technical Forum and also builds and maintains relationships with the Nigerian National Malaria Elimination Program, local companies and other key partners committed to fighting the disease.
Prior to GBCHealth, Ochuko was a Research Fellow with the Institute for Advanced Medical Research and Training in Ibadan on a WHO-funded malaria program to improve the health of children living with malaria in western Nigeria. She has also worked with Boehringer Ingelheim as a Senior Medical Representative.
Dr. Peter Olumese
Dr. Olumese is the Medical Officer for Prevention Diagnosis and Treatment in the Global Malaria Programme at the World Health Organization. He has been a Medical officer with the Global Malaria Programme Department since 2001. One of his main products is the WHO Guidelines for the Treatment of Malaria now in its 3rd edition. Dr. Olumese has been a Pediatrician and clinical pharmacologist for more than 24 years and he has served as Co-chairman of the Roll Back Malaria Country and Regional Support Partners Committee (formally Harmonization Working Group) since 2009.
Dr. Kolawole Maxwell
Dr. Maxwell is a Community Health Physician with experience in planning and managing health activities at community, facility & policy levels. His experience also includes working with a range of multi-lateral and bi-lateral donors, central government, national implementing institutions, local authorities, NGOs, international and local consultants. He’s currently the West Africa Programme Director for Malaria Consortium.
Dr. Francis Aminu
Dr. Aminu is the Director of Health & Nutrition, Aliko Dangote Foundation. He is a Development Nutrition Specialist with more than 20 years of professional and cognate experience in program management and organizational development in nutrition, food and health systems. Dr. Aminu has a proven experience working effectively with various stakeholders, including government officials, donor and development agencies, civil society actors and clients with in-depth knowledge of the political, economic and socio-cultural characteristics of Nigeria and some countries in Africa.