Fighting malnutrition in Somalia in the time of coronavirus
Tags: Nutrition, Partnerships, Somalia, Children, Unicef

Mohamed Ali Warsame, just one year old, gazes up at the health worker as she measures the circumference of his upper arm. It’s an important indicator to help assess his nutritional status, and determine if he needs to keep receiving supplementary food. The health worker’s face is concealed by a disposable surgical mask, and her hands covered by latex gloves, but little Mohamed isn’t alarmed. Over the last few months, through the COVID-19 pandemic, he’s probably become accustomed to seeing the staff at the Shangani health centre in Mogadishu wearing this kind of protective gear.

“He has visited the centre four times now, to participate in the targeted supplementary feeding programme,” explains his mother, 30-year old Barwaaqo Aden Abdi.

Mohamed and Barwaaqo are participants in a programme in Somalia to combat moderate and severe acute malnutrition, jointly implemented by the United Nations World Food Programme (WFP) and the United Nations Children’s Fund (UNICEF) and supported by funding from Germany. Both United Nations agencies are working with the Somali Ministry of Health on the initiative, which combines UNICEF’s malnutrition prevention and treatment programme and water, sanitation and hygiene interventions with WFP’s targeted supplementary feeding and mother and child health and nutrition programmes — specifically designed to treat and prevent malnutrition.

Interventions to fight malnutrition are critically important in Somalia. More than ten percent of children under five suffer from wasting, a result of several factors including inadequate access to clean water and nutritious food.

“My husband works on a donkey cart, and provides the whole income for our family. Unfortunately it is not enough to feed and educate our children,” says Barwaaqo.

Shamso Ibrahim Aden — another participant in the programme, who has come to the centre with her 14-month old son Abdi Herow Hussein — has a similar story. She and her husband were farmers but, after being displaced by civil conflict, they must now rely on the money he makes providing wheelbarrow transport services.

“There are no other sources of income that support us, except for WFP’s support,” she says.

The outbreak of COVID-19, which reached Somalia in March 2020, has posed serious challenges for the nutrition initiative. Movement restrictions, brought in to reduce transmission risk, have made it more difficult for participants, as well as WFP and UNICEF staff and partners, to reach the health centres. (To adapt to this, the frequency of programme sessions has been altered in some cases.) It’s also been necessary to suspend or change some measurements used for nutrition screening, to minimize physical contact.

And in many cases, fear of the pandemic has kept mothers and children at home — and away from the health centres, which are key sites for implementing the initiative through the measurement and tracking of key indicators and the distribution of food supplements.

To reassure participants so they feel comfortable returning to the health centres, and to help protect both them and the staff assisting them, WFP and UNICEF have made significant changes to how the programme is implemented over the last few months. They have also been sensitizing communities on the new measures.

Everyone has their temperature checked on arrival at the centres, conducted at a safe distance with non-contact infra-red thermometers, so that anyone with possible COVID-19 symptoms can be screened and referred appropriately.

Temperature checking outside a health centre. Photo: WFP/Ismail Taxta

Then there is mandatory hand-washing for everyone entering the health facilities, both for programme participants and staff.

Mandatory handwashing before entering a health centre. Photo: WFP/Ismail Taxta

Once inside, mothers and children wait on chairs or benches set up to ensure safe social distancing. Health workers are on hand to provide tailored information and education while they wait. Pregnant women and mothers visiting for the first time receive useful facts on health, nutrition, and the registration processes at the center, while returning participants can access counselling and information about other services that they may be able to benefit from.

An information session at a health centre. Photo: WFP/Ismail Taxta

Registration is conducted at a safe distance by staff in personal protective equipment (PPE) — masks and gloves — with plenty of hand sanitizer available.

Registration at a health centre, with staff in PPE. Photo: WFP/Ismail Taxta

Programme participants then have their children’s key measurements taken to indicate their nutrition status. These measurements include the upper arm checks that Mohamed has just undergone.

Nutrition programme participants wait to have their children’s measurements taken, with social distancing in effect. Photo: WFP/Ismail Taxta

Staff, fully equipped with PPE, are on hand to ensure the nutrition indicators for every participant are carefully tracked and recorded against their individual records, using special cards issued to each of them.

Recording key nutrition indicators. Photo: WFP/Ismail Taxta

Finally, participants receive packets of special supplementary food to boost the nutrition for themselves and their children — again, with as little contact as possible, and with staff wearing gloves, masks and aprons to keep everyone safe.

Collecting supplementary food. Photo: WFP/Ismail Taxta

All through the process, the changes made to protect people from COVID-19 are highly visible — and WFP and UNICEF staff and partners, as well as participants, have needed to adapt quickly. But the changes have been necessary. The programme is too important to be allow it to be disrupted by the virus, ensuring that children like Abdi Hedrow Hussein can get the nutrition they need for proper physical and mental development despite the ongoing pandemic.

“This is our sixth visit to the centre for the targeted supplementary feeding programme,” smiles Shamsi. She proudly holds up her son Abdi, who has been putting on some healthy weight. “It is helping with his malnourishment.”