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).
Program to Combat Maternal and Child Malnutrition in the Republic of Gambia
Recent performances
Renewal of the MoU for the period 2023-2026
During 2023, together with the Gambian Ministry of Health (MoH) and the National Nutritional Agency (NaNA), the new collaboration agreement has been signed for the period 2023-2026. Furthermore, this latest memorandum focuses on strengthening CREN as a dynamic and safe space to promote nutritional health and its treatment. In addition, it has the support of those responsible for the Ministry of Regional Government, Lands and Religious Affairs; the Regional Health Directorate (RHT), of the Upper River Region (URR) and the Lower River Region (LRR); the Senior Nutrition Officer in the field, in URR and LRR; Basse District Hospital (URR) and Soma (LRR); and the Basse and Soma Region Council.
Contexto General
La República de Gambia es uno de los países más pequeños de África Occidental y está rodeada por la República de Senegal en los lados norte, este y sur, y delimitada por el Océano Atlántico en el oeste. Tiene una superficie total de aproximadamente 11.000 kilómetros cuadrados y una población de unos 2,2 millones de habitantes. Se organiza en 5 regiones administrativas y la capital: Región de Lower River, Región de Central River, Región North Bank, Región Upper River, Región Western y la ciudad de Banjul.El país tiene un Índice de Desarrollo Humano (IDH) de 174 de 179 naciones (2021) y está clasificada como un país de "bajos ingresos" y con "déficit de alimentos". Aproximadamente un 73,9% de la población en zonas rurales vive por debajo del umbral de pobreza y uno de cada cien gambiano se encuentra en situación de inseguridad alimentaria, mientras que uno de cada tres es vulnerable a la inseguridad alimentaria.
Particular Challenges
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.
Escazes de producto F-75 y F-100
Durante años, UNICEF había proporcionado a hospitales y CRENOS los productos F75 y F100, que permitían recuperar a niños y personas en casos de desnutrición severa aguda. El acuerdo era que UNICEF proveía los productos a condición de que el gobierno Gambià realizara el pago de una parte del precio. Debido a la crisis económica el gobierno dejó de realizar este pago y UNICEF dejó de proporcionar el producto, dejando en 2022 las poblaciones más vulnerables desamparadas
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.
Acuerdos con terceros países
Gambia ha llegado a varios acuerdos con terceros estados que han hecho disminuir la cantidad de alimentos disponibles en el país y han subido sus precios. Gambia y Senegal acordaron que los pescadores de ambos países pudieran vender el pescado en el país vecino. A los pescadores gambianos les salía más a cuenta vender el pescado en Dakar y dejaron de venderlo en Gambia, llevando a la escasez de la principal fuente de proteína de las comunidades más desfavorecidas. El acuerdo entre Gambia y la Unión Europea les permite pescar en las costas gambianas ha reduciendo la reducción del pescado disponible. Asimismo el acuerdo con la instalación de tres factorías chinas que acaparan el pescado para producir harina de pescado como comida para cerdos y aves y que sirve para exportar a China, supone también la falta de abastecimiento de pescado por los mercados locales.
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
