How Lily recovered from Severe Acute Malnutrition (SAM)

Seven-year-old Lily Sual recovered from Severe Acute Malnutrition. ©UNICEF/PNG/Chambers/2017

Seven-year-old Lily borrowed her older sister’s clothes to wear for her last visit to the pediatric ward at the Kundiawa General Hospital in Chimbu Province where her treatment for severe acute malnutrition (SAM) is being monitored.

“Several weeks ago, Lily was very thin. She’s been sick for a long time. She was losing weight rapidly and her clothes were too big for her to wear so her mother and I asked the village tailor to have her clothes altered so she could fit into them,”Lily’s father, Sual Dimino, explains in Tok Pisin, the local dialect.

“Within two weeks of eating the peanut butter paste, my daughter started gaining weight and now her clothes can’t fit her again. Everyone in the village sees the difference in her and they keep asking me what I feed her. That’s why she borrowed her older sister’s clothes,” Sual adds with a broad grin.

Sual Dimino (left) gets a couple of plumpy nut sachets for Lily (centre) while Sister in Charge of the Paediatric Ward, Agnes Danguma looks on.

Lily was one of 52 children identified as suffering from SAM by health workers at Kundiawa General Hospital when they conducted an integrated community outreach health service in Kagma, her village in the Sina Sina District in early February, 2017.

The integrated outreach service includes a community-based approach to screen children for malnutrition as part of an Integrated Management of Acute Malnutrition (IMAM) strategy that UNICEF supports in four provinces including Chimbu Province.

In late 2016, the Kundiawa Hospital integrated the community based approach into routine outreach health care services to bring nutrition services to communities for families and children affected by SAM. This approach involves timely detection of SAM in the community and provision of treatment for those without medical complications, usually with Plumpy Nut, a ready-to-use peanut based nutrient-dense therapeutic paste that boosts a malnourished child’s chances of survival. Plumpy nut does not need clean water to swallow; it does not need to be cooked or refrigerated, and it stays fresh even after opening.

Until recently, the treatment for SAM was limited to hospital-based care where children received milk-based formula and medical care. Often by the time these children made it to a hospital, they would have already developed medical complications which would require hospitalization for urgent treatment due to that fact that out of ignorance parents or care givers would not consider the child to be sick until they started wasting.

Dr. Guapo Kiagi (left) measures Lily’s middle upper arm circumference while Sr. Agnes Danguma (right) measures her height.

“When we found Lily, she was frail and skinny. Not only was she wasted but she was also too short for her age, a typical SAM case. We immediately started her on the Outpatient Therapeutic Care Program and supplied her with Plumpy Nut,” explains Dr Guapo Kiagi, a Paediatrician at Kundiawa Hospital who identified Lily during an outreach program.

Lily’s father, Sual, deeply concerned for his daughter’s health, committed to a weekly therapeutic treatment. He brought Lily to the main hospital regularly for her progress to be monitored. Since starting her treatment on February 4, Lily’s weight increased from just over 14 kilograms to close to 19 kilograms in under four weeks.

Sual is impressed with his daughter’s recovery and even more amazed when told at the hospital that Lily is well enough to go off the treatment because she has reached a point where she can be taken off the treatment. This means Sual doesn’t have to bring Lily back to the hospital and he is pleased.

“I’m so happy for Lily. My wife and I learned proper feeding practices from this program and that is what we will practice from now on to make sure Lily never gets this sick again,” he states.

Sual (right) is a proud dad. Lily is well enough to go off the SAM treatment.

All forms of malnutrition are persistent in Papua New Guinea Over 45 percent of the children are stunted and 14 percent are wasted. At Kundiawa Hospital, while malnutrition ranks as the fourth common cause of disease burden in children under five years of age, Dr. Kiagi explains that malnutrition is the leading cause of death amongst children.

Malnutrition admissions at Kundiawa Hospital declined in 2014 from 314 cases to 173 in 2015. Malnutrition deaths declined from 66 in 2014 to 31 in 2015.

Feeding time at the Paediatric Ward in Kundiawa Hospital. A nursing sister prepares therapeutic milk for malnourished children.

Community-based management of SAM has the potential to be implemented on a large scale and that could prevent the deaths of thousands of children in Papua New Guinea if it is also properly combined with hospital-based care for malnourished children with medical complications.