Southern Sudan -- At eight months old, Kau was severely malnourished and dehydrated. He was suffering from a series of infections, had diarrhoea, pneumonia, and didn't want to drink. Without appropriate treatment, he would have died.

Kau is typical of many young children in Medair's feeding programme who have not been getting the nutrients that they need. When he came to the clinic, Kau received a full medical review, followed by a prescription of appropriate medication including antibiotic injections. He was then assessed by the nutritionist and prescribed a re-feeding regime.

First, he needed to be rehydrated with a special solution used for malnourished children. He was also given first-stage therapeutic formula milk. With small, frequent feedings and encouragement from his mother and the nutrition staff, he started to drink. After two days Kau had regained his appetite. He was able to finish the prescribed formula and also to breastfeed. He progressed to the second-stage formula and began to gain weight.

The treatment process was not without its setbacks. Kau developed an eye infection, and he lost his appetite for a few days due to a fever after his measles vaccination. Fortunately, he was attending the clinic daily so his health issues could be dealt with quickly.

One month later, Kau has reached his target weight and is ready to be discharged. His mother has been encouraged to continue to breastfeed, and been given advice about weaning him onto appropriate foods. "Kau's progress has been excellent," said Alice Wyatt, Medair's Nutritional Manager. "It's fortunate that his mother was able to bring him for treatment when she did. Once we started appropriate treatment, his recovery was rapid".

Treatment and prevention in Melut County

Malnutrition is a serious problem in Melut County, where Medair runs a Primary Health Care Centre (PHCC) and provides community therapeutic care for nutrition. In Melut, over 20 percent of children under five are malnourished.

There are many root causes of this malnourishment. In Kau's case, lack of knowledge about infant feeding and disease combined to lead to his life-threatening situation. Diarrhoea is also a cause of malnutrition in young children, which is a major problem in Upper Nile due to poor water and sanitation. Families in this region also suffer from inadequate access to food. This is particularly acute in the months leading up to the harvest times in November and December.

Medair is working in Melut to both prevent and treat malnutrition. The nutrition programme admits severely malnourished children and adults to the PHCC for therapeutic feeding. In addition, during the "hunger gap" between August and December, we carry out a supplementary feeding programme in a number of communities around the county. This provides additional food to children under five and to pregnant and breastfeeding women who are moderately malnourished.

Medair is also working to spread the message about age-appropriate feeding for children, promoting breastfeeding and providing education about what foods to feed young children. Medair's WatSan teams also have a role to play in preventing malnutrition, by improving access to safe water and sanitation.

The bigger health picture: Nyabach's story

Medair's nutrition programme works in close conjunction with our primary health care programme. Malnourished children almost always have multiple health problems and need skilled medical care, in addition to nutritional treatment.

Nyabach is a two-and-a-half-year-old girl who was recently admitted to Medair's nutrition programme. Her mother brought her two hours by boat from a village on the other side of the Nile to receive free treatment. When she arrived at the clinic, her 'weight for height' was very low, she had severe swelling in her feet and ankles, and her skin was in bad condition. All of these symptoms indicated that she was suffering from severe malnutrition.

After five days of treatment where she was fed through a tube, Nyabach started to regain her appetite. Unfortunately the swelling in her legs did not improve. The clinic team discussed the situation and determined that other causes needed to be investigated. A test in the PHCC's lab revealed that she was losing protein into her urine, which was why she was not responding to nutritional treatment. Now able to receive appropriate treatment, Nyabach has continued to improve under both medical and nutritional care.

Working with malnourished children is often an emotional rollercoaster. When admitted for therapeutic feeding, the children are very sick and unfortunately we cannot help all of them.

"Many children are so malnourished that they are barely able to walk and refuse to eat or drink, and that is difficult to witness," said Alice. "But when you are able to later see them walk out of the clinic healthy, happy, and well-fed, it is so rewarding. You know that the work you are doing is really making a difference."

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Medair is an international non-governmental organisation (NGO), with its operational headquarters located in Switzerland. Its Relief & Rehabilitation programmes in Southern Sudan have been running since 1992.

In Southern Sudan, Medair provides emergency medical and water assistance for outbreaks, large people movements, and nutritional emergencies in a number of locations across the region as well as improving access to primary health care and safe water sources in Upper Nile. In the northern states, Medair provides access to primary health care and water and sanitation for up to 210,000 conflict-affected persons in West Darfur; works with war-displaced people in Khartoum; and supports access to primary health care in the Nuba Mountains in South Kordofan.

Medair's work in Southern Sudan is currently supported with the assistance of UNICEF, BSF (DFID - British Government and Worldbank), BUZA (Dutch Government), SDC/DDC (Swiss Agency for Development and Cooperation), The Humanitarian Aid Department of the European Commission (ECHO), ERF (Emergency Response Fund/UNDP administrated by OCHA) and CHF (the United Nation 'Common Humanitarian Fund for Sudan) and private donors.

Medair's life-saving activities are also dependent upon private financial support. To contribute to this work, please visit www.medair.org (Southern Sudan section.)