As the measles epidemic gradually fades in the Tanganyika province of the Democratic Republic of Congo, malaria and malnutrition often form a deadly combination for children. In order to face this situation, MSF – in collaboration with the Congolese Ministry of Health – continues to support the Manono health zone for the management of severe acute malnutrition and pediatric emergencies and is opening a similar project in Kabalo.

"In a region where supplies to treat severe acute malnutrition are constantly out of stock, leaving after the measles epidemic amounted to abandoning the malnourished children to their fate, especially those who had survived measles," says Narcisse Wega, an MSF emergency coordinator. Indeed, more than half of the 2,345 children being taken care of in the ambulatory therapeutic feeding centres of the Manono health zone were affected by measles in the previous month.

"Measles destabilized an already fragile nutritional situation, with very diverse local dynamics," explains Narcisse. "In the mining areas, ore prices fell by half; some villages are isolated because of their ethnic composition; other pockets suffer from the poor variety of their diet, sometimes composed exclusively of cassava; persisiting traditions such as the replacement of breastmilk with other foods also play a part."

In the Manono health area, the organization supports 27 health centres with medicines and diagnostic tests for malaria, and opened ambulatory therapeutic feeding centres in more than fifteen remote health areas which are extremely difficult to access. A system is also in place to ensure the coverage of the remaining health centres. Awareness sessions are organized in villages and active case detection is set up in the community through community relays.

In these isolated villages, a transfer system of motorcycles and canoes has been put into place to allow children in serious conditions to be hospitalized. "Functional and free transportation are essential for medical emergencies to reach hospital," says Narcisse.

In Manono General Hospital six medical tents have been set up by MSF. The teams support the paediatric emergency room, where over 80% of patients suffer from malaria, often with severe anaemia requiring blood transfusion. The intensive care unit is operating at full speed since its opening on 19 January 2016, with 1424 patients already admitted.

"A malnourished child is a universe in itself," says Dr. Freddy, head of the unit. "Malnutrition does not only slow growth, it weakens the immune system against the most common diseases. And the young children are the first affected."

The intensive therapeutic feeding unit is made up of fifty additional beds. The first phase of treatment is to accustom their bodies to digest, while treating medical complications. The children then enter a phase of nutritional rehabilitation and can be monitored as outpatients.

MSF is preparing to open a similar project in Kabalo in response to another worrying nutritional situation.

The health situation remains fragile in the Tanganyika province. Access to care is often limited and the health system in place today is regularly unable to cope with emergencies such as this year’s measles or measles post-crisis epidemic. Within months, MSF teams have vaccinated almost a million children aged between six months and 15 years old and treated nearly 30,000 sick children against measles. In this area of acute malnutrition, MSF is now facing a lack of actors and funding for the treatment of this pathology.

Other MSF teams support the health system through prevention and treatment of common diseases such as malaria, malnutrition and cholera in the areas of Kalemie, Shamwana, Kinkondja or Nyunzu.