Working in partnership to support women, children and adolescent girls in Liberia

Introduction

Before The Power of Nutrition’s first partnership in Liberia, stunting prevalence in the country was extremely high, at 31%. The first programme aimed to change this by addressing the immediate causes of malnutrition through direct nutrition interventions, such as treating severe acute malnutrition and counselling women on appropriate infant and young child feeding practices. Despite the progress made (such as treating more than 67,000 children for severe acute malnutrition and halving the percentage of children who are wasted), stunting remained stubbornly high, at 30%. Likewise, levels of anaemia among women of child-bearing age were at 45%, which increases the risk of low birth weight babies who are more vulnerable to illness or death. It was clear that there needed to be a follow-on programme in Liberia to build on progress but also adapt interventions to the changing needs of the population.

Our programme

The programme builds on the achievements, momentum and key lessons learnt from our first in Liberia that ran from 2017 to 2020. The first phase laid the foundation that enabled national delivery of high-impact interventions at scale, through strengthening the health system and the enabling environment for nutrition. The goal of the the second Liberia programme was to continue supporting the Government of Liberia in implementing its new National Nutrition Programme. The programme focused on strengthening both preventive interventions and treatment within health facilities; strengthening social and behaviour change communication to create demand for services; enhancing behaviour change to increase effectiveness of interventions; and further scaling preventative services to underserved communities to reach more mothers and children. The programme also piloted and scaled high-impact interventions that specifically targeted adolescent girls, who were previously unable to access nutrition interventions but comprise of 38% of pregnant women.

Esther's story

Esther, a nine-month-old baby, smiled cheerfully at the nurses when she was brought in for her follow up visit at the Ganta clinic. Esther was admitted twice in the nutrition programme taking place at the clinic.

Esther’s grandfather Wotoe Dahn works as a registrar at the clinic, and he is raising Esther after she lost her mother and twin sister. He explains that when Esther reached six months of age, she became very thin and weak when he had to rush her to the Ganta community clinic, where she was diagnosed with severe acute malnutrition.

When Esther was taken to the facility in September 2022, she was so thin, weak, and restless; she kept crying and sucking on her fingers. She weighed around 3.5 kg with a mid-upper arm circumference of 11 cm, which meets the criteria for admission in the Outpatient programme. “She was so sick that people in the community thought she will not make it. Fortunately, she started gaining strength and gradually gained weight and became a happy baby again. She stayed in the programme for a few weeks and was discharged when her weight reached 5 kg,” said Teewon Karnue, the Screener at the clinic.

Esther was brought back into the clinic after three months where she received treatment and was placed on micronutrient powder to improve her complementary feeding. Mr. Karnue explained that Esther relapsed because of the poor complementary feeding by her grandparents who are low-income earners.

According to her grandfather Mr. Dahn, they fed her with cassava and soup mostly since that’s what they eat, but when she relapsed, we were advised to feed her with different food like plantain, pawpaw, eggs, and other food besides cassava. The clinic also offered vitamins which are now being added to the food that Esther receives.

Esther is one of the many babies who were fortunate to get a second chance at life through the nutrition interventions in Liberia.

Programme achievements

The programme’s support to the government led to the successful integration of nutrition interventions into Liberian policies and strategies, ensuring enhanced ownership and increased sustainability. It also led to the development of a national social and behaviour change strategy, which addresses the primary causes of stunting in the country. The Liberian Government was supported to develop a budgeted plan to support exclusive breastfeeding, particularly important because the Ebola epidemic (which could be spread through breastfeeding) increased people’s use of breastmilk substitutes.

It enabled the expansion of the Integrated Management of Acute Malnutrition programme from 127 to 289 health facilities across the country. This means that facilities were able to treat severe acute malnutrition in 81,616 children.

Many adolescents were also reached through the programme. As of March 2023, 279 schools were providing direct nutrition interventions and 75,641 adolescent girls received iron and folic acid supplementation. On top of these figures for adolescents, 492,413 pregnant women also received iron and folic acid supplementation and 816,743 pregnant women benefitted from maternal, infant and young child feeding counselling, surpassing the programme’s target by 119.5%.

Next steps

Together with UNICEF we’re looking for further resources to explore opportunities for a third phase of the programme, given its progress and success in reaching women, children and adolescents in need of essential nutrition services. Whilst huge progress has been made, more investment is needed to sustain this.

Read about the phase of our programme in Liberia here.

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Photo credits 

Banner image: UNICEF/Liberia/2016/2/Masama Karama and Fata Sheriff in Sarkonedu Lofa County Liberia 1

First body image: UNICEF/Liberia/2023/ Lynda Dahn, Member, Women Support Group House Hold Gardener, harvests in her garden during nutrition awareness activities in Gwein town, Grand Gedeh County, Liberia

Footer image: UNICEF/Liberia/2023 Newborn at WHO clinic, Margibi.