Sierra Leone is ranked as one of the five countries with the highest global hunger index. Undernutrition is a serious problem, yet as the western African nation has moved on and become less fragile in the decade since the end of its civil war, nutrition policy has also shifted its focus from treatment to prevention.

The international community is working with Sierra Leone’s government to address undernutrition. The Secure Livelihoods Research Consortium (SLRC) has just published a report looking at whether current efforts to build government capacity to prevent undernutrition are ‘fit for purpose’, given the constraints it faces.

SLRC/Richard Mallett

Left: A farmer from a Farmer Field School in Kambia district. Improving nutrition depends upon diversifying and improving diets, which are traditionally heavily rice-based. Farmer Field Schools – initially set up across the country to improve agricultural productivity – have started teaching farmers to grow more nutritious crops and are connecting them with markets to sell the produce. Although food security is a widely recognized issue in the fight against hunger, many of these schools receive insufficient support.

SLRC/Richard Mallett

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Above: Peripheral Health Units (PHUs) in Kambia District. The number of underweight children in Sierra Leone has increased by 24 per cent since 2000, despite the country’s post-conflict economic growth. Peripheral Health Units (PHUs) such as this one in Kambia District are at the frontline of delivering community healthcare and provide nutrition services. At present there are 1,228 PHUs across the country.

SLRC/Richard Mallett

Above: A child recently treated for malnutrition in Kambia District. PHUs, mother-to-mother support groups and community health workers face the challenge of confronting cultural beliefs that can exacerbate malnutrition. For instance, in many parts of Sierra Leone it is commonly thought that protein-rich foods, like meat and eggs, are bad for children, whereas in fact they are crucial for a healthy diet. Mothers are often blamed for unhealthy children and this can discourage them from seeking early treatment for their children at PHUs. This child has recently been treated for malnutrition, but there are many cases where late referrals put the health and lives of children at risk.

Mother-to-mother support groups have been established with the help of development partners across the country. These groups work with mothers at a community level on child nutrition and promote the use of health services provided by PHUs, such as early diagnosis and preventive treatment.

SLRC/Richard Mallett

Above: Referral slips given to mothers by Community Health Workers for different child health concerns. Community health workers also help to detect undernutrition in remote communities. They are trained in assessing children for malnutrition and refer any potential cases to the nearest PHU.

SLRC/Richard Mallett

Above: Hazardous roads during rainy season. Also known as the lean season due to high levels of food insecurity, roads are even more hazardous than usual, making it difficult for PHU workers to do outreach work in remote communities.

SLRC/Richard Mallett

Above: A map showing the catchment area this PHU aims to serve. Each PHU serves approximately 5,000 people. Some villages in the PHU catchment areas are located several miles away, and staff are often not provided with motorized vehicles to travel to and from the various communities. Even when they are, they often cannot afford the fuel.

SLRC/Richard Mallett

Left: A nurse working at Kambia's Peripheral Health Units. The Peripheral Health Units are staffed by small number of nurses and aides who are responsible for implementing Community-based Management of Acute Malnutrition (CMAM). PHU staff collect information regarding rates of malnutrition and pass this onto the District Health Management Teams, so that rates of malnutrition can be monitored and the required treatment amounts administered. However, high levels of staff turnover, insufficient training and some cases of misappropriation of resources, mean that at a number of PHUs there are shortages of therapeutic drugs and feeding supplies.

Find out more about the Secure Livelihoods Research Consortium.

Read the other stories in our ‘In pictures’ series on local community projects: A dance project in Nottingham, UK, the Crystal Palace music festival, and literacy classes in the Philippines.

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