Malnutrition and malaria are common in remote communities in Angola, especially during peaks of drought and heavy rain. Women and their children are most affected. For the last year, Médecins Sans Frontières (MSF) has collaborated with local health authorities to reduce the burden of these diseases in the provinces of Huíla and Benguela.

“It’s hard to get to the health post, it takes me two hours' walking,” says Domingas Luciana after a consultation for her daughter, Florença, at a mobile clinic run by MSF in Camassissa community, a remote area of southwestern Angola’s Huíla province. “[My daughter] was born very skinny and wouldn’t get better.”

Florença was diagnosed with severe acute malnutrition and malaria, so she was enrolled in MSF’s outpatient malnutrition programme at the local hospital and given medications for malaria. In just three weeks, her health significantly improved.

“Since I have been taking her to this mobile clinic and to the hospital for follow up [care], Florença has been getting better,” says Domingas. “I get very happy seeing that my baby has recovered.”

Reaching mothers and their children in remote communities

It’s common for children to have both malnutrition and malaria at the same time. Malaria, the deadly mosquito-borne disease, is prevalent in Angola and was diagnosed in 80 per cent of the more than 29,800 medical consultations MSF provided between February and June 2023, in Huíla province’s Chipindo and Cuvango municipalities.

While the disease can be fatal if not treated —particularly in young children— in some areas of Huíla, timely diagnosis and treatment is challenging.

“A lot of communities here live very far from a health facility,” says Isabel Severino, MSF health promotion and community engagement supervisor in Cuvango.

To reach people who live too far from health facilities, MSF teams conducted mobile clinics and trained community health workers to treat mild cases of malaria and other diseases in their communities and identify children that need additional care at one of the 17 health structures supported by MSF.

“Usually, women [come to] me because they’re the ones taking care of the kids,” says Joana Mandavela, a community health worker from Cuvango. “I take care of their kids like I take care of mine.”

MSF also supported a referral system with motorbikes, known locally as kaleluias, to transport mothers and their children to health facilities. This addressed one of the hurdles many women faced to access healthcare. During the time it was operating, the referral system transferred 300 patients to reach medical care.

Supporting children’s recovery in health facilities

Children with moderate and severe acute malnutrition were enrolled in MSF’s outpatient programme, where they received ready-to-use therapeutic food, known as Plumpy’nut, as well as kits including blankets, cups, and soap. Children in a critical state were admitted to the inpatient malnutrition unit in the hospital.

MSF treated 710 children for acute malnutrition, including two-year-old Rosa.

“When Rosa was admitted at Cuvango Municipal Hospital, she had blisters all over her body,” says Isabel Zua, an MSF psychologist. “She spent a lot of time in bed and lost some of her mobility. So, after a few weeks, as she started getting better, we began to also do psycho-stimulation with her. After two sessions we could already see a big difference.”

Psychologists like Isabel try to re-establish mobility, cognition, confidence, and the mother to child bond after a child has been in a critical condition in the hospital for an extended period.

“She is a lot better, and I am very happy,” says Paulina Kassombo, Rosa’s mother.

Building capacity and structures for the long run

Beyond the medical work, MSF’s logistics and water and sanitation teams also rehabilitated health structures and waste zones, and completed other construction projects, including re-building a crucial bridge that had had been destroyed with the use and connected more than 10 remote villages with the health centre in Galangue.

As part of the response in Angola, MSF conducted training with dozens of Angolan staff, staff from the Ministry of Health, and community health workers at various health facilities, focusing on malaria, malnutrition and the treatment of patients in critical condition.

“The best way to prevent diseases in the long run is by leaving some knowledge and tools behind that help to transform the behavior and [practices] of [medical] professionals and the local [community],” says Luis Montiel, MSF’s emergency coordinator for Huíla.

Following three consecutive years of severe drought in Angola and soaring food prices, in 2021 UN agencies alerted that these issues could have an impact on child malnutrition, particularly in the southern provinces of the country. MSF carried out assessments and started medical activities in several locations in Angola in 2022.

In Huíla, rapid assessments did not show an alarming rate of malnutrition and drought was not as serious as predicted. However, malaria rates were very high and remote communities faced many challenges in accessing healthcare. In this province, MSF teams completed mobile clinics in late May and handed over our support to local health facilities to the Ministry of Health in June. As part of this handover, MSF donated supplies, motorbikes, and motorised tricycles to ensure that referrals of patients can continue.