Program to Combat Maternal and Child Malnutrition in the Republic of Gambia
Nutrition Without Borders (NSF) has a 15-year history in Gambia with the objective of strengthening maternal and child nutritional security and food sovereignty of communities by supporting sustainable and endogenous agricultural and community development, always with an intersectional perspective.
In this regard, NSF has constructed and operationalized two Maternal and Child Recovery Centers (CRENs) in the regions of Soma and Basse with the support of local counterparts, specifically the Ministry of Health of Gambia (MOH), the Health District (RHT), Governors of the Upper and Lower River regions, and the National Nutritional Agency (NaNA).
Recent performances
205 CHILDREN ADMITTED TO OVERCOME MALNUTRITION IN THE CREN OF BASSE, GAMBIA IN 2023
The inflation in prices of the basic food basket has resulted in a 14% increase in admissions compared to the 180 recorded in 2022. Additionally, seasonal hunger is increasingly concentrated during the months when families have exhausted their food reserves (from July to October).
As the majority of the population depends on agriculture, there is a strong seasonality in the increase of hunger around the harvest season, especially in the third or fourth quarter of the year. This can be observed in the admission data at the CREN.
205 BABIES ADMITTED IN 2023
We also observe that 10% of the babies are under 6 months old, and the gender breakdown indicates equal care for boys and girls.
Of the babies admitted to the CREN, 180 stabilized and were successfully discharged, 14 were referred to the hospital, 6 were discharged with home follow-up for nutritional support, 2 were discharged voluntarily, and unfortunately, 3 died.
Currently, a new agreement has been signed between Nutrition Without Borders and the health authorities of Gambia for the period 2023-2026.
Recognizing the need to reinvigorate the management of CREN in recent years and acknowledging the challenges of the international context characterized by increasing food vulnerability worldwide, a unanimous agreement has been reached on the necessity to take preventive action and enter a new phase of co-management focused on strengthening the Nutritional Recovery and Education Centers (CRENs) in Basse and Soma as dynamic and safe spaces to promote nutritional health and its treatment for the period 2023-2026.
The signing of the new Cooperation Agreement (MOU) has been vital, as it has led the Gambian authorities, specifically the Ministry of Health and the National Nutrition Agency (NANA), to recognize the importance of not only focusing on treating malnutrition but also strengthening capacities for prevention and early diagnosis through community screenings.
The alarming public health situation data published by WHO underscores the urgency of our efforts. Therefore, we have aimed to incorporate a joint co-management effort focused on six of the Sustainable Development Goals.
The healthcare staff at CREN has increased their preventive efforts by conducting talks within the CREN premises for both hospitalized families and those babies who, due to their less severe condition, only come for weekly follow-up appointments. They also provide support with nutritional supplements.
As a tool to disseminate health and nutrition messages, posters have been created with various themes and local designs to easily capture attention, accompanied by short texts in English and local languages such as Wolof and Pular.
Three posters have been edited: the first provides guidelines for improving nutrition education, the second focuses on preventive measures for pregnant and expectant mothers, and the third addresses prevention strategies to combat malaria proliferation.
With the support of co-development, we are working on methodologies and mechanisms to promote the materials for Intercultural Community Nutrition Education. Therefore, a logo has been designed based on the materials developed through a participatory workshop involving all local workers at CREN.
59 CHILDREN ADMITTED TO OVERCOME MALNUTRITION IN CREN IN SOMA, GAMBIA IN 2023
59 CHILDREN ADMITTED TO OVERCOME MALNUTRITION IN CREN IN SOMA, GAMBIA IN 2023
The Republic of Gambia is one of the smallest countries in West Africa, bordered by the Republic of Senegal on the north, east, and south sides, and bounded by the Atlantic Ocean on the west. It has a total area of approximately 11,000 square kilometers and a population of around 2.2 million people. The country is organized into 5 administrative regions and the capital city: Lower River Region, Central River Region, North Bank Region, Upper River Region, Western Region, and the city of Banjul.
Gambia has a Human Development Index (HDI) rank of 174 out of 179 nations (2021) and is classified as a "low-income" and "food-deficit" country. Approximately 73.9% of the rural population lives below the poverty line, and one out of every hundred Gambians faces food insecurity, while one out of every three is vulnerable to food insecurity.
General Context
Particular Challenges:
Soma
Agricultural Sector
The agriculture in Gambia is characterized by mixed farming with limited diversification, mainly focused on subsistence production (upon which 60% of its population depends). The main crops grown include dryland cereals such as pearl millet, late millet, maize, sorghum, and rice. Additionally, there are semi-intensive crops like peanuts, cotton, and sesame, among others.
Agriculture contributes to 22% of Gambia's GDP as of 2021 and employs 68% of the population. Women make up half of the agricultural workforce and generate around 40% of the agricultural production.
Impact of the COVID-19 Pandemic
The pandemic worsened nutritional conditions in Gambia. As the country relies on food imports due to subsistence agriculture, border closures led to reduced food availability throughout 2020, especially affecting fish, which was a primary source of protein for the population.
Food shortages were accompanied by significant price inflation, reducing families' purchasing power.
Scarcity of F-75 and F-100 Products
For years, UNICEF had provided hospitals and CRENs with F75 and F100 products, essential for the recovery of children and individuals suffering from severe acute malnutrition. The agreement was that UNICEF would supply these products on the condition that the Gambian government paid a portion of the price. Due to the economic crisis, the government stopped making these payments, leading UNICEF to cease providing the products. This situation left the most vulnerable populations helpless in 2022.
Agreements with Third Countries:
Gambia has entered into several agreements with third-party states that have reduced the quantity of available food in the country and increased prices. Gambia and Senegal agreed that fishermen from both countries could sell fish in the neighboring country. It became more profitable for Gambian fishermen to sell their fish in Dakar, leading them to stop selling it in Gambia, resulting in a shortage of the main protein source for the most disadvantaged communities. The agreement between Gambia and the European Union allows EU fishing fleets to operate in Gambian waters, further reducing the available fish. Additionally, the agreement involving the establishment of three Chinese factories, which monopolize fish to produce fishmeal for pigs and poultry, primarily for export to China, also contributes to the lack of local fish supply for local markets.
Women
Gambia banned female genital mutilation (FGM) by law in 2016, a practice that has affected 75% of Gambian women. Despite the legal prohibition, it continues predominantly in rural areas under very precarious hygiene and medical conditions, leading to serious health impacts for mutilated women. The situation worsens in cases of the most severe type of mutilation (Type III), which involves infibulation. The Sustainable Development Goals (SDGs), especially SDG 5, aim to eradicate this practice by 2030.
Women's rights are a global struggle, and NSF (Nutrition Without Borders) actively works to integrate training and empowerment programs for women in the communities it serves. NSF recognizes that empowering women is crucial for improving the health of children. Women play a pivotal role in enhancing the economy, health, and education within their communities. NSF is committed to supporting lactating and pregnant mothers by ensuring access to nutritious diets and conducting awareness campaigns on good dietary practices during pregnancy.
Centers for Recovery and Nutritional Education (CREN)
NSF, through the CRENs, carries out multiple activities:
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Treatment of cases of malnutrition
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Nutritional screenings in communities
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Training activities for healthcare personnel
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Training activities for communities
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Promotion of food sovereignty
Activities
Attention to cases of malnutrition
The CRENs have the capacity to simultaneously accommodate up to 25 children under 5 years old who are admitted with severe acute malnutrition, along with their mothers, until they are ready to return home (typically staying at the center for 15 to 20 days).
During their stay, the children receive healthcare and nutritional treatment based on the guidelines for malnutrition management from the World Health Organization (WHO), United Nations Children's Fund (UNICEF), and the National Nutritional Agency (NaNA).
During 2021, a total of 173 children were treated at the CREN in Basse, consisting of 57% boys and 43% girls. At the CREN in Soma, 90 children were attended to, comprising 63% boys and 37% girls.
The CREN and the services it provides have become a model of reference that can be implemented in other regions of Gambia affected by malnutrition. Specifically, the importance of CREN lies in its ability to ensure specialized care for critically malnourished children, providing them with adequate recovery spaces. Additionally, NSF has implemented a series of activities within CREN that have contributed to professionalizing healthcare personnel, providing training for communities, and empowering women, especially pregnant and lactating mothers.
Nutritional screenings of communities
To assess the nutritional status of children and detect cases of malnutrition, nutritional screenings are conducted in community villages within the regions.
During visits to these villages, a medical record is created for each child, they are weighed and measured to evaluate their nutritional status, and their development is monitored over time. Children with severe acute malnutrition are referred to CREN (Nutritional Recovery Centers), while children with moderate acute malnutrition receive treatment within the community.
Periodic screenings have enabled coverage of 90-95% of children and detected virtually all cases of malnutrition in the populations where interventions took place.
Correct nutritional status
Risk of malnutrition
Moderate malnutrition
Severe malnutrition
Training activities for healthcare personnel
Training of the country's healthcare personnel in the detection, management, and treatment of Moderate Acute Malnutrition. Additionally, professional practices are conducted for national healthcare personnel at the CRENs (Nutritional Recovery and Education Centers).
Community training activities
Training for community members to detect cases of child malnutrition and simultaneously promote good hygiene and food safety habits.
NSF focuses on training and empowering women within communities. During the admission of children, mothers receive training on nutrition, maternal and child health, and food safety.
Through the operation of CRENs, NSF has identified that children's health depends significantly on the health and education level of pregnant and lactating mothers. In this context, as part of the process to strengthen CRENs to support not only children but also mothers, NSF has launched an awareness campaign in communities, particularly targeting mothers, regarding good feeding practices for children.
Posters have been designed in a way that women can relate to the information being conveyed. Similarly, the content is developed in both local languages (Fula and Wolof), in addition to English.
Tedugall Food Processing Product
NSF has supported the production of "Tedugall Food Processing" in the locality of Dongoroba. This product is entirely handmade using rice, maize, peanuts, millet, and beans. Its highly nutritious and protein-rich content accelerates the recovery of children over 6 months old and adults suffering from malnutrition.
Ensuring the distribution of this product and making it available at the CREN in Basse has a dual positive impact. Firstly, it contributes to the recovery of women and children at the Basse CREN, especially during periods when UNICEF's F75 and F100 products are unavailable. Secondly, it strengthens and promotes local production of the product and food sovereignty. This initiative improves the health and food security conditions for pregnant and lactating women, as well as children over 6 months old, by providing locally produced highly nutritious products and promoting food sovereignty.
Stop Malaria
During August 2022, the NGO Stop Malaria collaborated with NSF to ensure the installation of mosquito nets in the CRENs to prevent the transmission of this disease, particularly protecting pregnant women and children under 5 years old.
Stop Malaria has been working since 2008 to reduce the incidence and deaths from malaria in Gambia. The mosquito nets installed are always impregnated with long-lasting insecticide and are locally produced.
Furthermore, taking advantage of the collaboration, NSF has jointly developed with Stop Malaria an awareness poster about precautionary measures against the disease to educate communities, especially pregnant mothers and children who are the most vulnerable groups.
The poster has been drafted in both local languages (Fula and Wolof) as well as English, making it easier for the message to reach the communities. The campaign content is summarized in the following points:
1. Cover or turn over outdoor containers to prevent water from attracting mosquitoes.
2. Repair holes in mosquito nets before the rainy season.
3. Apply insecticide to mosquito nets if it has been more than 2 years since the last application.
4. Install mosquito nets in sleeping areas.
5. Visit the health centre if you notice symptoms of Malaria, especially for pregnant women or children under 5 years old.
The support for the program to fight against
maternal and infant child malnutrition
