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Script 109.9

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More than one-third of child deaths are due to malnutrition in the form of undernutrition, mostly from increased severity of disease. Children who are undernourished between conception and age two are at particularly high risk for impaired physical and cognitive development.

Many malnourished children who survive will never fully recover. Their growth will be stunted and their cognitive development retarded. In Burkina Faso, more than one in three (38%) children are stunted. The causes of childhood malnutrition are many. It often starts during pregnancy when 68 per cent of pregnant women experience anaemia due to poor nutrition and illnesses such as malaria. These conditions often result in the low weight of the child at birth.

Children under five years are especially vulnerable to preventable diseases such as malaria, diarrhoea, and pneumonia, which also leave a child malnourished and prone to other diseases. Once a child is weaned, they need an adequate and well balanced diet, which few have, often due to lack of knowledge about sound feeding practices.

This script focuses on how malnourished children in Burkina Faso are being helped through eating a mixture of foods called enriched or improved porridge, which is made with nutritious local foods. We hear from a health expert who describes how children with malnutrition are treated by health services in Burkina Faso, and explains the ingredients in the porridge and the process of making it.

We also hear from four mothers whose children were malnourished. They describe their experience with using and making enriched porridge, and how their children were helped by eating the food that is called “the porridge that saves.”

This script is based on actual interviews. You could use this script as inspiration to research and write a script on a similar topic in your area. Or you might choose to produce this script on your station, using voice actors to represent the speakers. If so, please make sure to tell your audience at the beginning of the program that the voices are those of actors, not the original people involved in the interviews.

You could also use this script as research material or as inspiration for creating your own programming on caring for malnourished children. Talk to health experts, and family members who care for these children. You might ask them:

• What are the signs or symptoms of childhood malnutrition?
• What are the most effective and affordable ways of treating these children?
• What are the best ways to prevent childhood malnutrition?

Apart from speaking directly to health experts and families who have dealt with childhood nutrition, you could use these questions as the basis for a phone-in or text-in program.

The estimated running time for this item, with signature tune, intro, and extro, is 15-20 minutes.

Script

HOST:
Ladies and gentlemen, welcome to today’s program all about child malnutrition.

In West Africa, 11% of children, or seven million, suffer from acute malnutrition, and 36% or 25 million, suffer from chronic malnutrition. According to the United Nations, the number of children who suffer from chronic malnutrition decreased from 35% to 30% between 2009 and 2015. During the same period, the percentage of children who suffer from acute malnutrition decreased from 11% to 10%. Despite this decrease, more than one million children still suffer from chronic malnutrition in Burkina Faso, and one child in three is at high risk of dying from infectious diseases caused by malnutrition.

To tackle child malnutrition, nutrition stakeholders have developed a mixture of foods called enriched porridge or improved porridge that is made with nutritious local foods. It’s this porridge that we call “the porridge that saves” that we are going to talk about in this program.

To talk about it, we invited two people to our radio station today. Later, we will air interviews with mothers of children with acute malnutrition, recorded in the field.

Maadou Ramdé is a nutrition expert in the health district of Koudougou, one of the biggest cities in Burkina Faso, and Mrs. Rasmata Tondé is a mother from the rural district of Ramongo, a hundred kilometres west of the capital city, Ouagadougou. Her child suffered from malnutrition, and she treated him with enriched porridge.

We are going to talk about the porridge, including its ingredients, the availability of these ingredients, and especially how to prepare it.

TRANSITION MUSIC

HOST:
Mrs. Tondé and Mr. Ramdé, good morning and thanks for coming on our radio program to talk about malnutrition and enriched porridge.

Let’s start with you, Mr. Ramdé. First, is malnutrition a serious issue in your health district?

MR. RAMDÉ:
Yes. The matter is serious because malnutrition is a breeding ground for other diseases. It weakens children’s bodies and makes them vulnerable to diseases like malaria and diarrhoea.
HOST:
What is being done about this situation?
MR. RAMDÉ:
With the support of its partners, the Koudougou health district operates screening programs and then proceeds to treat children with malnutrition. The screening is done both in health centres and in communities. Screening in communities involves visiting households and measuring the circumference of children’s arms. If the results show that a child has symptoms of malnutrition, we refer him or her to health centres.
HOST:
And what is done for the children in these care centres?
MR. RAMDÉ:
First, you must understand that there are two levels of malnutrition. There is severe malnutrition and moderate malnutrition. Severe malnutrition has two types: severe malnutrition without any complication and severe malnutrition with complication, including edema or other related signs. We treat children with these two types of malnutrition in health and social promotion centres. In these places, we serve ready-to-use food to the children. There are two types of ready-made food that we give to children with malnutrition—Plumpy’Nut for children with severe malnutrition and Plumpy’Sup for children with moderate malnutrition. These are ready-to-use therapeutic foods that contain a wide variety of nutrients that are meant to cure these children’s malnutrition. But since there is often a shortage of these foods, we also show mothers how to prepare enriched porridge.
HOST:
What about children who suffer from severe malnutrition with complications? How do you treat them?
MR. RAMDÉ:
If children have serious symptoms such as edema in which the skin sinks when you press it and does not quickly return to normal or signs such as anorexia, or refusal to eat, fever, or cough, they are suffering from severe malnutrition with complications. They must be referred to better-equipped centres. This is because these children may have other health issues in addition to malnutrition. These other facilities will provide more appropriate care.
HOST:
Plumpy’Nut and Plumpy’Sup are therapeutic foods that help treat children with malnutrition. These are pharmaceutical products, which are not often available and accessible to everybody, especially in rural areas. To address this issue, nutritionists introduced a food they call enriched or improved porridge. Mr. Ramdé, what exactly is this improved porridge?
MR. RAMDÉ:
It’s a porridge that not only includes three groups of essential food nutrients—fats, carbohydrates, and proteins, but also micronutrients, which are of great importance to intellectual development. We teach mothers how to make this porridge from foods they have home. We also show them that they can prepare this porridge with commercially available flours produced locally by NGOs and associations and available in drug stores and some pharmaceutical warehouses in health centres.
HOST:
Can the mother of a child find these ingredients locally in the village?
MR. RAMDÉ:
Yes. Communities have in their houses all the required food groups and nutrients that a child under five years needs to be healthy. Mothers, their husbands, and their families only need to be trained to identify these foods and nutrients, and how to find, process, and mix them to make improved porridge according to quite simple dosages.
Enriched or improved flours are sold on site in villages at quite affordable prices in various places. In health centres, mothers are taught during demonstration sessions how to identify the required local foods and also how to prepare enriched porridge.
TRANSITION MUSIC

HOST:
We have learned that, in Burkina Faso, we treat moderately malnourished children with improved porridge made with local foods, and we teach mothers of the kids suffering from this type of malnutrition to prepare it.

Now we are going to talk with our expert and with a mother who succeeded in treating her child suffering from malnutrition with enriched porridge. We will talk about which ingredients are used to prepare this enriched porridge, how it is prepared, and especially how mothers of malnourished children can learn to take care of their kids on their own.

We will start with Mrs. Rasmata Tondé from the village of Ramongo. Mrs. Tondé, how did you discover this enriched porridge?

MRS. TONDÉ:
My child was sick and very thin; when I took him to the health centre, they told me he was suffering from malnutrition. The health workers invited me to attend sessions on how to prepare enriched porridge.
HOST:
Did your child drink the porridge the first time you cooked it for him?
MRS. TONDÉ:
I didn’t add sugar to the porridge the first time. He drank it, but not enough. The other times, I added some sugar and he drank it well. He recovered from malnutrition.
HOST:
Which ingredients did you need to make this improved or enriched porridge?
MRS. TONDÉ:
You need pearl millet, maize, or sorghum; you need beans and groundnuts. You must clean the millet very well to remove all dirt and stones. Avoid dehulling the pearl millet or the sorghum or beans because the rich part is in the skin. You must roast and grind everything to get flour. For the quantity, if you measure six small measures of millet, you should add one measure of beans and one measure of groundnuts. You can use other cereals such as maize and sorghum, but the health workers advised us to use pearl millet when it’s available because it is richer in nutrients.
HOST:
Can you find all the recommended ingredients locally in your village?
MRS. TONDÉ:
In fact, people in the village grow everything we need to prepare this porridge. There is no need to look for them elsewhere. The small challenge is to collect them—and especially to ensure that they are clean.
HOST:
Mr. Ramdé, tell me how the health centres teach the mothers about enriched porridge?
MR. RAMDÉ:
We teach mothers to make enriched porridge during antenatal checkup appointments at hospitals, but most often during weekly follow-up visits to children suffering from malnutrition. In this case, mothers bring all the necessary ingredients from home, and the health workers demonstrate the various steps. During the following sessions, women who understood the technique teach those who didn’t understood well or who were absent at the first sessions—with the help of the health workers.
HOST:
Mrs. Tondé, was it difficult for you to understand how to prepare the enriched porridge?
MRS. TONDÉ:
No, not at all. There is nothing extraordinary or difficult about it. These are things we do every day, but we don’t do it with all the necessary ingredients. Every day, we roast millet, groundnuts, and other foods to make porridge or sauces. But for these children with malnutrition, it is important to maintain cleanliness to make sure that children who are already sick don’t get other diseases.
HOST:
Is there anything you would add to Mrs. Tonde’s explanation of the cooking process, Mr. Ramdé?
MR. RAMDÉ:
Well, you can add some sugar, salt, oil, and dried fish to make sure the children get all the nutrients their bodies need.

To make the porridge itself, you boil some water, pour the hot water into the flour, mix it, and stir well. Then, put the mixture on the fire for ten minutes maximum—and the porridge is ready.

HOST:
Mrs. Tondé, did you show the techniques for making the improved porridge to other women in the village or at the health centre?
MRS. TONDÉ:
Yes, at the health centre. Some mothers returned to tell me that they had cooked it and that it was good for their kids. This porridge can help tackle malnutrition.
HOST:
Thanks, Mrs. Tondé and thanks, Mr. Ramdé.
MR. RAMDÉ:
I am the one who should thank you because you are helping us through these programs to tackle malnutrition, which is a public health issue in Burkina Faso.
HOST:
We were speaking with Mr. Maadou Ramdé, a nutrition expert, and Mrs. Rasmata Tondé, the mother of a child who was suffering from malnutrition and who was treated with enriched porridge. Our guests told us how to cook enriched porridge to treat children suffering from malnutrition.

(PAUSE) Salamata Ouédraogo and Ramata Diallo are two women from the rural district of Boussouma, a hundred kilometres north of Ouagadougou. Both have small boys about 10 months old who are suffering from severe malnutrition. And both boys were cared for at the nutritional rehabilitation and education centre of the Centre Médical avec Antennes Chirugicales, in Boussouma.

Mrs. Ouédraogo, how did your child find himself in this situation?

SALAMATA:
The child was sick, and was refusing to take any kind of food. So I took him to get some treatment, and they told me he was suffering from malnutrition. His case was so serious that they sent me to the regional hospital of Kaya, 20 kilometres from there. He weighed only 5.5 kilograms. He was hospitalized there for quite a while. He received a lot of treatments, and they gave him various foods, including milk and syrup. He has recovered a lot.
HOST:
Did you receive any advice about providing better care to your children when you return home?
SALAMATA:
Yes. The health officers advised me mainly to be clean, and to cook some soup and porridge for the child. I also learned to cook a porridge with flour made up of many products, including millet, beans, groundnuts, fish, oil, soumbala (a local spice made with néré seeds) and sugar or salt. All these products must be clean.
HOST:
Do you have all the products used for this porridge in the village or do you need to go elsewhere to look for them—and at what cost?
SALAMATA:
The season was bad this year, so for products such as groundnuts and beans, we needed to buy them at the market. But when the season was good, we have everything in the village and we don’t have any problem getting these products.
HOST:
Was this porridge good for your child?
SALAMATA:
Yes. The porridge helped a lot. My child is feeling much better now. He couldn’t even feed himself and we were obliged to feed him through his nostrils. Now, he feeds himself normally.
HOST:
How did it happen that your child was malnourished when you have everything in the village to feed him?
SALAMATA:
I must confess I don’t know. Maybe the health officer will be able to tell us. Maybe it is because of diseases. When a child is sick he or she doesn’t eat, and malnutrition can occur. Anyhow, we cook the soup and the porridge for the children.
HOST:
Mrs. Diallo, you belong to a family of herders and besides breast milk, you have cow’s milk. Do you know whey your child suffers from malnutrition?
RASMATA DIALLO:
It seems that my milk is not good, and it is because of this that my child did not gain weight and suffered from malnutrition. I learned about this when I went for a check-up because the child was coughing. After he was hospitalized, I started preparing the improved porridge with some enriched flour that I bought at the drug store in the medical centre. To prepare it, you need two ladles of water for every one ladle of flour to get the mixture right. I also learned to make the flour by myself. Now, the child is feeling a lot better. He weighed three kilograms when he was hospitalized, and now he weighs 5.6 kilograms. I still give him some improved porridge, and I breastfeed him regularly because health workers told me that my milk was good for the child. I also give some cow’s milk sometimes.
HOST:
Ladies and gentlemen, this is the end of our program. We talked about how to treat children with malnutrition. With a nutritional specialist and mothers of children who suffered from malnutrition, we mainly talked about treating malnourished children with enriched porridge. We listed the ingredients used to make this porridge and gave instructions on how to cook it. Thanks for tuning in. We hope you learned many things during this program.

Acknowledgements

Contributed by: Harouna Sana, journalist, Burkina Faso
Reviewed by: Christophe Ouédraogo, health specialist, WUSC-Burkina Faso

This work was created with the support of the Government of Canada, through Global Affairs Canada, as part of the project, “Projet d’Amélioration de la Santé des Mères et des Enfants.” This work is implemented by World University Service of Canada (WUSC) in partnership with BURCASO (Conseil Burkinabé des ONG, OBC et Associations de lutte contre les IST/VIH/SIDA) and SEMUS (Solidarité et entraide mutuelle au Sahel).

Information Sources

Interviews:
Maadou Ramdé, nutrition focal point, Health district of Koudougou, April 11, 2018
Mrs. Tondé, resident of the rural district of Ramongo, April 28, 2018
Rasmata Diallo, resident of Boussouma district, May 16, 2018
Salamata Ouédraogo, resident of Boussouma district, May 16, 2018
Noélie Zabsonré, midwife, health centre of Boussouma, May 16, 2018
Justin Kaboré, head nurse of Godin Health and Social Promotion Centre (CSPS), health district of Koudougou, April 10, 2018