Ethiopian health system battles with severe malnutrition

THIS week, reporter Halima Athumani was at Ethiopia’s Dubti Hospital in the northern Afar region, where admissions of severely malnourished children are rising by 30% a month and hospitals are seeing a mortality rate of up to 12%.

DUBTI Hospital is the only national referral hospital in the Afar region, one of the regions in northern Ethiopia. And here, because of the conflict, many hospitals or small health centres have been destroyed.

Because of that, many people have to come to Dubti Hospital for treatment, and one of the major things they handle is malnutrition. According to the doctors here, malnutrition is one of the most significant disease burdens that they have currently.

And this is not just within Afar alone. This is actually around the whole of Ethiopia. The rise in cases of hunger caused by the worst drought in 40 years has hit agriculture and livestock in eastern and southern Ethiopia.

Around 8 million people have been affected, including half a million people who have been displaced in search of water, pasture, and healthcare. While the violence in the north has recently calmed, the UN humanitarian affairs office says malnutrition rates are rising in the Afar Region, with a 30% increase in hospital admissions of severely malnourished children in March and a similar increase in April.

Dubti hospital is one of the most affected healthcare facilities in the region. As soon as you enter the gate into the hospital, one of the first things that will hit you is the fact that there are beds within the corridors.

You will find mothers lying with their babies. Doctors are making rounds to help these mothers who’ve been here, some for more than two weeks, some for more than three weeks, and they’re all here seeking treatment.

And Dubti hospital is the only Regional Hospital in Afar, and this is where everyone comes to. Every case has failed in different centres called the stabilisation centres within Afar.

The UN says communities in northern Ethiopia need fertiliser and seeds for the upcoming growing season known as Mihir.

They also need veterinary vaccines and treatment drugs. More than 9 million people around the country need urgent assistance. But support organisations are desperately short of the fuel required to deliver food aid. And many have been forced to reduce or suspend deliveries since May 8.

Dr Muhammad, the acting CEO of the hospital, says: “We expect malnutrition in increments from March to the end of June because there will be no rain between these months. We can say 90% (the population) are pastoralists. So they depend on their livestock. Whenever there is no rain and drought, the livestock’s products, such as milk, will be decreased, affecting the children in the household.

“We have seen mortality rates of 12% for the past three months from the cases we have admitted. Most of the patient deaths were due to severe complications like shock and complicated pneumonia. Also, malnutrition compromises the immune system.

“People go to traditional healers. After that fails, they will come to health facilities. Some of the children we treat have burn scars on them. When we ask why the child has the scar, the parents say the traditional healer puts some heat meters on them, and some will give them grass or something like that as medication, but that won’t heal.

“The condition worsens. And also, when the patient or the children become severely complicated, they start to seek a waiver when that condition is mild or moderate. They will not seek help first, maybe due to the poor health-seeking waiver – secondly, the distance, where they live, and the health service available in their area. Thirdly, the transportation system. There is no adequate transportation system in our region.”

In a recent report it was said that when some patients come here, they die within 48 hours of their arrival.

“As I said, most malnourished kids come with complications, especially shock that will be difficult to manage. Even though they are given fluids and anatropic drugs, some patients will not respond. Some will come with a terminal or end-stage of the disease.

“Besides, this is the referral hospital within the Afar region for many of these patients to go to. The problem is the health posts and health centres are not functioning well. So if they go to the health centre, they will not find adequate service.

“They will not find the service that manages to monitor. “When they try to refer their patients, the ambulance is not available, causing another problem. If available, the patients will arrive late because their health-seeking behaviour is poor from the beginning,” said Dr Muhammad.

When asked how easily available the supplies at Dubti Hospital are, especially those that treat malnutrition. Muhammad said the reserves are adequate for the treatment of the children at the hospital and that after they recover, a letter is written to a health facility to register the child as outpatient therapeutic feeding patients.

“That health centre will supply them with plumpness, but in some of the health centres, the problem is they don’t have the plumpness. They may run out of it or not get the supply. If the child is not the only child in the household, they may share it with him, which will cause a shortage. So that will not be enough for them. So the relapse cases are there. We have seen relapse cases again and again.”

Do these mothers get advice on what to do when they return home?

“We counsel them, but they tell you we will provide what is available in the house. So we counsel them. We say it’s better if you do this, this, this, this and provide special attention for the younger children. They say that we will do what we can. They are pastoralists. They don’t have money on their hands. They may sell their cattle or goats, or sheep. Maybe the markets will be once a week. So after that they will try to sustain their livelihood by providing a small amount of food.”

“So the root cause of malnutrition is sustainable agriculture in pastoralists’ lives. I remember when I was a kid, we poured our milk on the ground because it was full. Everyone had extra milk. They wasted it. I remember a single guy used to have 100 cattle. Even my father used to have 100 cattle. Now my father has 12. That shows a continuous drought in the Afar region for the past 10 years. And the worst drought is happening now. The last time this occurred was in 1994, around eastern Africa, I think 30 or 40 years ago.”

Do you think this is because of climate change? Many people are complaining about weather changes and stuff in your view. I know you’re a doctor, but I’m just wondering, do you think it is because of climate change?

“Yes, climate change. I remember where only the cattle horns were seen due to the tall grass. Now, if you go everywhere in Africa, you won’t see that grass. I remember there were three rainy seasons per year. Now it’s hard to get a single rainy season. It is climate change. And also, the demographics are changing due to policy reasons. The other thing that worries me is that people are neglected and don’t get attention. Much of the investment has not been made in the region. This affects the people in the region and makes them disadvantaged.”

♦ This piece was produced by SciDev. Net’s Sub-Saharan Africa English desk.