It is a sunny morning in the coastal town of Tombo, western Sierra Leone and Mohamed Mansaray, a Community Health Worker (CHW), embarks on his weekly visits to families in his bustling community.

His first stop is the home of 17-month-old Baimba, who has recently won a battle with malnutrition. Nine months ago, during one of such visits, Baimba’s mid-upper arm circumference (MUAC) was in the red zone and he was identified as severely malnourished. Baimba was swiftly referred to the nearest health center equipped to treat malnutrition cases.

This morning, Mohamed, equipped with his training in community case screening and identification and ready with his MUAC tape, approaches each house in the community with a sense of purpose. He screens every child under five, watching out for signs of fever, diarrhoea and other childhood illnesses, and measures the circumference of each arm with a MUAC tape. He refers children whose arm circumference fall in the red zone of the tape for treatment in nearby health facilities and offers nutritional advice and counselling to parents and caregivers of those who fall in the yellow zone. He encourages those whose arms fall in the green zone to continue with their good feeding practices.

“As CHWs, our role is not just about treating childhood illnesses but screening children for any warning signs, identifying cases for referral and preventing malnutrition through early nutrition counselling. Aminata needed urgent help so I referred her,” Mohamed shares, underscoring the importance of the specialized training he received to enable him to recognize the signs of malnutrition promptly.

Aminata, Baimba’s mother, said that she was really worried about her son and thought she might lose him, but when Baimba started getting treatment for malnutrition at the Tombo Health Center, her worries began to go away, “Just a few days after eating that paste, I saw a big change in Baimba. He looked so much better,” Aminata thankfully recounted, “The treatment really works, and I knew that he would become strong and healthy again,” she added.

Aminata was referring to the Ready to Use Therapeutic Food (RUTF) that was used to treat Baimba.

In Sierra Leone, malnutrition remains a significant threat to the overall health and well-being of children, limiting their potential to thrive, learn, and earn later in life. According to the National Nutrition Survey 2021 report, 26 per cent of children under five years are stunted, 5 per cent are wasted, and 1 per cent are severely wasted. There are more than 60,000 cases of severe acute malnutrition annually among children under five years, and due to the high food insecurity in the country, more children are at risk of becoming malnourished if preventive actions are not taken.

With thanks to the generous contribution from the Government of Japan, UNICEF has been working with partners, including the Ministry of Health, to address malnutrition in the country. Through this partnership, 2,289 CHWs have been trained on case identification, and referral rates have improved. Severe Acute Malnutrition (SAM) treatment coverage among children aged 6-59 months has been enhanced, and treatment services have begun for severely malnourished pregnant and lactating women in five target districts (Western Area Urban/Rural, Bo, Kenema, and Kailahun).

“The focus of our Nutrition programme is to provide timely and good quality nutrition services, including building a sustainable network of frontline workers who can identify, manage, and refer cases effectively. It is about empowering communities to address malnutrition at its roots,” Brenda Kaijuka Muwaga, Nutrition Specialist at UNICEF stated.

Reflecting on his role, Mohamed added, “We don’t stop at screening, identifying and referring cases. Our work also involves continuous learning, adapting, and contributing to a system that can save more lives.” The programme extends to empowering caregivers to regularly measure the arm circumference of their children to detect malnutrition early in their households. The performance of CHWs is also regularly assessed through the data they collect and report.

Christiana Cole, the District Nutritionist, highlighted the significance of this holistic approach, “It is not only about treating the child but ensuring they receive comprehensive care and support for long-term recovery,” she explains.

As Mohamed wraps up his visit to Baimba’s family, he encourages Aminata to keep feeding him well, and to protect him from malaria and other diseases to ensure he stays healthy.