One of the areas served by CSCOMSEKASI is Sibiribougou, a peri-urban community. The health center regularly sees some of the highest numbers of malnutrition cases in Commune IV. Sometimes, it has the highest number of cases in all of Bamako.

One of the children who became sick in March was Natenin, age 4. She and her younger sister, age 19 months, live with their parents in Sibiribougou and participate in our community health program.

Our team quickly got to work to organize a nutrition demonstration, a strategy used to help mothers learn to prepare foods which support their children’s development. Led by a nutritionist from the national health program, the session showed mothers how to prepare a porridge enriched with local ingredients, like carrots and pumpkin.

The nutritionist shared that a major factor in malnutrition is repeatedly feeding children the same foods, which does not allow them to have a variety of nutrients. The porridge mothers learned to make is prepared with affordable local products that are available year-round; it provides balanced nutrition that ensures the good growth of children.

We invited 25 mothers with children under age 2 from our program to come to the health center for the demonstration. They were joined by our community health workers, the nutrition staff at the health center, and other mothers from Sibiribougou.

She began by sharing the recipe, explaining the ingredients, quantities, and the method :

Ingredients
2kg of sorghum
2kg of wheat
2kg of fonio
1kg of corn
1kg of rice
5kg of baobab flour
10 carrots
1 medium pumpkin
1 tablespoon of salt
10kg of sugar
1 small container of peanut oil

Preparation
Wash each grain well separately
Mix them in the same container and grind them
Sift the mixed flour and set aside
Sift the baobab flour well
Mix the two flours and set aside
Wash the vegetables well
Boil and mash them

Then, she got to cooking, inviting mothers to help her at each step.

Cooking
Boil 10 liters of water in a clean pot
When water is lukewarm, using a calabash and a ladle, slowly mix some water into the flour mixture until blended
Pour the solution back into the pot
Mix and stir until a homogeneous mixture is obtained
Then add the mash made of carrot and pumpkin to the porridge and simmer for about 5 minutes.
Then add the salt, sugar and a cup of oil
Let stand a few minutes before serving

Then came the best part – the tasting! All the children attending enjoyed the portions they were served, giving their full approval of this new dish. Mothers equally approved. They not only liked the taste, but appreciated that the ingredients were local and accessible. These nutrition demonstrations not only give mothers access to important health information, it also facilitates a permanent change to more nutritious meals in their households.

At the end of the session, Natenin’s mother addressed the group. She thanked the nutritionist for sharing this information and advice, and with it, vowed that her children would never know malnutrition again.

When mothers are supported with information and resources to keep their children healthy, the results are astounding. While a 2017 UNICEF study found the national rate of acute malnutrition in Mali rested at 10.7%, we had just 14 cases of acute malnutrition among the 2,350 children served by our community health program in 2020. Putting mothers at the heart of health interventions works. Strong community health systems react quickly to community needs by keeping women and mothers at the heart of local, accessible solutions.

Kadidiatou is proud to share that Awa, the mother she told us was very reticent about going to the health center, did find her way back there, as did almost all of the families in Lafiabougou who had stopped seeking care due to rumors and concerns about COVID-19.  After Kadidiatou talked Awa through her concerns and let her know that the visits would be safe, Awa returned to the health center for her prenatal care, and gave birth in August without any trouble.

You may also remember that Kadidiatou had a niece who was infected with the coronavirus, which was a scary time for her family. Her niece recovered, and Kadidiatou went to see her in June to hear about her experience, which encouraged her to work harder to prevent others from going through the same thing.

Kadidiatou reports that she has been able to share the messages of preventing COVID-19 more widely. She has been able to convince her neighbors to adopt prevention measures, including installing hand washing kits at the entry of their homes. She reports that more people in her community are limiting their movements and wearing masks regularly.

Kadidiatou also noted that the training that Mali Health was able to do with community leaders about how to combat misinformation and to encourage preventive measures and behaviors made a noticeable difference in improving the knowledge and awareness of members of her community. With these precautions and the progress she has observed, Kadidiatou is confident that Lafiabougou is prepared and will stay safe :

I believe that today, my community is strong enough to avoid COVID-19.

Kadidiatou, Mali Health community health supervisor

Learn more about the work of Kadidiatou and our community health workers here.

Sonata Cissogo, a friend and neighbor, became their community health worker. Sonata shares, “The family’s first daughter, Amitou, was about three and a half years old in 2011. Since that time, I have been working with this family as it has grown from one to four children. The next three children were all enrolled at birth.” Fatoumata notes, “We have known Sonata for many years. Every day she comes over to greet us and the children. If the children show any sign or symptoms of illness she tells us to take them to the health center immediately.”

Amitou, now a healthy nine-year-old enrolled in school, helps to look after her three younger siblings—a brother, Seydou, age 7, and sisters Aminata, age 5, and Niekoro, age 2. Neither Fatoumata nor Alimata work, leaving Fatoumata’s husband, N’Golo, the sole provider for the family. Alimata reflects on how the family agonized over what to do when their oldest child became ill: “before Amitou was first enrolled, my son would say to buy traditional medicine to treat her illnesses. Traditional medicine is cheaper, but it doesn’t always work. Now, since my grandchildren have been enrolled in Mali Health’s program, my son tells us to take the kids to the health center right away. Now he is content, and he and my daughter-in-law don’t struggle about it anymore.”

Amitou, Seydou and Aminata have grown up with access to basic primary care whenever they needed it – and today, they are strong and healthy. The youngest, Niekoro, is still covered and just recently became ill. Her mother describes her relief at being able to act quickly to take care of her daughter. “As soon as I recognized the signs, my husband and I agreed that I would take her to the local health center just down the hill. I bring the health card that Mali Health gave us and that helps a lot with the doctor. Before, without the card, the doctor would be scared that you would not have enough money to pay. Sometimes you would only have maybe $2 or $4 in hand, and the doctor and the medicine might be $6 – $10, or more. So, we wouldn’t be able to buy the medicine and would have to get traditional medicine instead. Now with the Mali Health card, the doctor is very nice, and he gives us the consultation and medicine, and we don’t have to wait long either.”

The benefits extend beyond just immediate access to healthcare for the Diarra family. “Now, with the money we would have spent on doctors and medicine, we use it to buy good healthy food, decent clothes for the children, and a bit goes to cover their monthly school fees too,” says Fatoumata. As she recounts her family’s story, she points to her daughter, Aminata, who, unprompted, grabbed a bucket and a bar of soap and is washing her hands. “Aminata learned to wash her hands with soap from Sonata. She taught everyone to do this regularly during the Ebola crisis, and Aminata has been doing it ever since.” Aminata turned five years old last June, graduating from the program.

“My son is thankful for Mali Health and for Sonata too,” says Alimata of her grandchildren’s participation in the program and the community health worker it has provided to their family. “We are all thankful.”

As we roll out the technology and help our team become accustomed to it, they recently learned how powerful this new tool could be. During a routine visit, our community health workers found a child urgently in need of care. But when she didn’t receive it, they used their training, backed by their mHealth data, to become her advocate. Here’s what happened:

Last week, one of our community health workers visited a mother whose 20-month-old child was underweight. Using her training, our health worker instructed the mother to seek treatment at their health center immediately.

The next day, four CHWs returned to the home to learn how to do a malnutrition follow-up using their new mobile application. The follow-up requires the CHW to recheck the weight and the brachial measurement of the child. The brachial measurement is the circumference of a child’s bicep, a common method of identifying malnutrition, and is indicated by a range of green, yellow, and red levels. This child’s brachial measurement was red, and the weight-for-age calculated by the mHealth app indicated severe malnutrition. The child only weighed about 6 kg.

The mother explained she had gone to the health center that morning for the malnutrition program, but was sent home. The staff said her child didn’t meet the criteria for the program; the young girl was not malnourished “enough” to receive treatment. Our team then decided to accompany them back to the health center, because the child was clearly in need.

However, as soon as they arrived, they encountered intense resistance from the staff. One claimed she remembered the child from earlier and that she weighed 10 kg — far more than the 6kg our health workers had measured. Our team insisted they check again.

The staff measured the girl again and placed her on their scale, determining this time that she weighed 7kg. Looking at their weight-for-height chart on the wall, the health center staff stated the child was only mildly malnourished. Our team insisted they weigh the girl again on our scales (which every community health worker carries on home visits). The staff agreed.

When they did, everyone saw the child only weighed 6 kg based on the scales of two different health workers. The staff claimed the scales were not correct, so our team insisted they take the girl’s brachial measurement. After more protest, a staff member finally took the measurement, but did not fully secure the measuring tape. She left a small gap between the tape and the child’s arm, so the result was yellow instead of red. When our team pointed out the error, the staff member stated that was how she learned to conduct a brachial measurement.

At this point, still determined to demonstrate the young girl needed care, one of our CHWs took the child to weigh her on the health center’s scale herself and, contrary to the staff’s measurements, and measured her at 6 kg. They continued to push for the child’s inclusion in the malnutrition program. After several minutes of discussion, the staff relented. A staff member retrieved several sachets of Plumpy’Nut, an effective nutrition supplement, and gave them to the girl’s mother.

Once home, our health workers explained how to deliver the supplement to her daughter most effectively. They encouraged the mothers to return to the health center each Wednesday to have her child weighed and to receive more of the supplement until she reached a healthy weight.

It took guts for our four health workers to stand up to the team at the health center. Without their intervention, the little girl never would have received care. Without care, a child with such severe malnutrition could die; in fact, it happens often. Mali Health CHWs are well-trained and they demonstrated their knowledge with confidence, even going against higher authorities in the health system when they knew those authorities were at fault.

Their story illustrates why a strong team of community health workers are so essential to advocating for mothers and children in their community. We are so very proud that ours had the courage to do exactly what they are trained to do: to make sure every mother and young child in their community has access to the best care possible.