Community-based care helps reduce child deaths

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This year, UNICEF’s flagship report, ‘The State of the World’s Children’ – to be launched on 15 January – addresses the need to close one of the greatest health divides between industrialized and developing countries: maternal mortality. Here is one in a series of related stories.

By Thomas Nybo

KOLDA, Senegal, 13 January 2009 – Daddo Sabaly's first four children all died before their first birthday, from either disease or malnutrition. Ms. Sabaly lives in the Kolda region of Senegal, which historically has had one of the country's highest rates of infant mortality. Her fifth child, a boy named Abdoulaye, is now five. Her sixth is a healthy nine-month-old girl.

Ms. Sabaly credits a community health centre for her children's survival, as well as a community nutrition programme that identifies local food resources such as squash, eggs and milk. Before this programme, feeding children these products was considered taboo.

"At first, Abdoulaye was suffering from malnutrition," she says. "But we went to the community centre, where I learned to properly feed him and he got better."

Community life-savers

The community centre is supported by UNICEF and offers mothers such as Ms. Sabaly a comprehensive approach to medical care. Infants are weighed and measured regularly to detect early malnutrition. Mothers are given micronutrient supplements and encouraged to exclusively breastfeed. They're also given insecticide-treated bed nets to ward off malaria – one of the top killers of children in Africa.

The Senegalese Government, with help from UNICEF and other partners, reduced malnutrition here from 22 per cent to 17 per cent in the 10 years leading up to 2005. UNICEF credits an aggressive approach that embraces the community as part of the solution.

UNICEF Representative in Senegal Ian Hopwood notes that the role of community-based health workers is just one proven strategy. “This has been best demonstrated by the whole experience of the community's treatment of acute respiratory infections," he says.

Another strategy is to involve grandmothers, who play an important guardian role in Senegalese society. Today, a group of women are gathered in a circle around a grandmother named Maimouna, who is telling young mothers about the importance of hygiene.

Large scale interventions

Dr. Guelaye Sall, a leading paediatrician and university professor in Senegal, is pushing the country to expand community-based programmes like the one in Kolda.

"It is imperative to apply this type of intervention on a large scale to lead to a reduction in child mortality," says Dr. Sall. "There must be a major effort to apply this across the whole country of Senegal in order to get the full benefit."

Half the children in Senegal who die under the age of five are less than one year old. Many die in the first hours and days of life. Creative approaches to help them survive this window of vulnerability must not only be encouraged – they must be replicated.

Ms. Sabaly and her two healthy children stand as living proof of what is possible.

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