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Case Study-Success Story from Cameroon

 

AHA’s nutrition team makes a special trip to Mandjou to meet with Hamadou Nourou, a nine year old boy they had met eight months ago. AHA came to know Hamadou during a HIV/AIDS and nutrition campaign conducted in Kwele village in Cameroon where refugees from the Central African Republic have settled. Hamadou was one of 93 malnourished children identified during the campaign and admitted at Belita II Health Center.

 

When admitted, Hamadou waited 9.5kg and suffered from severe acute malnutrition with medical complications. His mother and stepfather knew Hamadou needed medical attention but were unable to make the foot journey to the nearest health post. Having another infant who is also malnourished also diverted their attention from Hamadou.

 

Soon Hamadou was placed on systematic treatment:

Vitamin A 200.000 IU capsule single dose;

Folic acid 5mg tabs single dose;

Amoxicillin syrup 250mg/5ml 10ml x 2/day for 10 days;

Arsucam children 50mg/135mg 1 tab/day x 3days;

One week later

Mebendazole 100mg 4tabs as single dose,

Nutritional treatment:

Phase I: The child is stabilized by F-75 therapeutic milk in accordance to the CMAM protocol in this phase. Once the child shows improvement and his appetite returns, he moves to the Transition Phase;

 

Transition Phase: This phase is a transition from Phase I to Phase II where the readiness and wellbeing of the metabolic system for the digestion and absorption of high calories and high protein food will be tested. The child is introduced to F-100 therapeutic milk at small dosage.

Phase II: Rapid weight gain is expected in this phase, however after a month of treatment, Hamadou’s

condition remained very poor even deteriorated at times. A severe chronic illness was suspected the cause for Hamadou’s inadequate response to the treatments. Signs and symptoms of diseases which can easily be seen in healthy children are not clearly manifested in chronically malnourished children thus several tests were conducted including for HIV/AIDS and Tuberculosis (TB) which all cameback negative. As Hamadou’s health continued to deteriorate, fearing for his life, the medical team decided to start anti-TB treatment empirically suspecting he may be suffering from extra pulmonary tuberculosis. After two weeks of trying to acquire a pediatric preparation of anti- TB drugs, a committee of medical experts from AHA, the local TB treatment center and Batouri hospital decided to break the adult anti-TB drugs into pieces and administer per Hamadou’s body weight.

Hamadou responded well to this treatment and within two weeks his general condition, appetite and interaction with the hospital staff improved. He was no longer bedridden and was excited to restart walking again. Hamadou and his family continued to receive medical nutritional and psycho-social support. Two months after the commencement of anti tuberculosis therapy, Hamadou reached his target weight of 16kg, his mid-upper arm circumference (MUAC) measured 12.5cm and his appearance looked his age.

During routine checkups, Hamadou exhibited increased thoracic cage, fast breathing/tachycardia, dyspnea, and facial oedema/swelling. A chest x-ray revealed he suffered from cardiomegaly (an enlarged heart). Managing such conditions are beyond the capacities of district and regional hospitals, thus Hamadou was referred to Yaounde, the capital of Cameroon, under the care of the International Red Cross, where he received adequate medical treatment and returned to the refugee camp in Mandjou.

 

The AHA team finds Hamadou playing with his peers in the refugee compound. His mother, Halimata, greats the staff with a bright smile followed by tears of joy and appreciation of words for AHA. She tells spectators of her experience and the positive change in her child’s and family’s life. After many months of struggle and challenges, Hamadou is in good clinical condition; he eats well, plays and runs around with his friends. Halimata understands the cause of her children’s malnutrition and has been practicing the dietary and child caring training she was given.

In January 2010 the Cameroon Ministry of Public Health with support from UNHCR and AHA established an outpatient tratment program for severe acute malnutrition. Located in Batouri town 15Km from the nearest health center, the AHA Program Office conducts regular visits to small towns such as Kwele where we met Hamadou.