Very high and rapidly decreasing malnutrition and mortality in Banki IDP camp in northern Nigeria
Franck Ale1, Bahya-Batinda Dang2, Kaouther Chammam2, Moussa Ousmane2, Dorian Job3, Geza Harczi1, Klaudia Porten4, Iza Ciglenecki3, Hugues Robert-Nicoud3, Florent Uzzeni3, *Etienne Gignoux4
1Médecins Sans Frontières (MSF), Dakar, Senegal; 2MSF, Maroua, Cameroon; 3MSF, Geneva, Switzerland;4Epicentre, Paris, France
*
Introduction
Population displacement caused by the conflict in northern Nigeria has resulted in a major humanitarian crisis. In July, 2016, MSF crossed the Cameroonian border to reach Banki inNigeria’s Borno state, where some 20000 internally displaced persons (IDPs)had been confined for more than six months. A rapid health assessment of this population revealed high rates of mortality (4.2/10 000/day) and severe acute malnutrition (SAM) (14.3%). Due to security concerns, visits by MSF teams were limited to 3 days every 2 weeks. During these periods, teams provided care for sick and malnourished children, referred emergency cases, improved access to food and water, distributed three rounds of seasonal malaria chemoprevention (SMC), and expanded measles vaccination to children up to age 15 years.Children under 5 years received a 500 kcal ration of ready-to-use therapeutic food (1000 kcal for children with SAM). Mothers received a 12 kg-ration of high energy biscuits, soap, and a mosquito net. To monitor the situation, MSF organized repeated rapid mortality and malnutrition surveys.
Methods
Three surveys were conducted in mid-September, end of October, and mid-December, with recall periods of 57 days (first assessment to first survey), 42 days (first survey to second survey), and 58 days (second survey to third survey).We used random systematic sampling to select households. For the first two surveys, we estimated only mortalityusing a simplified household questionnaire (total number of family members, children 5 years, females, deaths during the recall period, and, for deceased members,age, sex , cause of death, and place of death). For the third survey, we collected individual data for all household members, including age and gender and the nutritional status of children 5 years (by mid-upper arm circumference or bilateral oedema).
Ethics
These data were collected for programmatic purposes to monitor the situation. This study was approved by the local authorities, result were shared with them. It was conducted with permission from Micaela Serafini, Operational Centre Geneva, MSF.
Results
We included 675, 921 and 926 households, respectively. Crude mortality rates decreased from 3.0 deaths/10000/day (95%CI 2.5-3.5) to 0.67 (95%CI 0.42-0.92) and finally 0.33 (95%CI 0.15-0.5). The under-5 mortality rate decreased from 5.6 deaths/10000/day (95%CI 4.4-7.1) to 1.70 (95%CI 0.96-2.44) and 1.0 (95%CI 0.4-1.6) respectively. In all three surveys, the main reported causes of mortality were malaria, diarrhoea, and malnutrition. In the third survey,malnutrition rates were low: global acute malnutrition was 3.0% (95%CI 1.8-4.1) and SAM 0.6% (0.1-1.1).
Conclusion
We present an overview of a humanitarian emergencyin Banki, Nigeria and efforts by MSF teams to provide assistancein a tenuous security situation. Despite difficult access, teams could organize a comprehensive, although simplified, targeted response through intermittent visits. With use of repetitive surveys, we were able to document a dramatic drop in mortality rates.
Conflicts of interest
None declared.