Curbing malnutrition is a community effort in Mongolia

Bujinkhuu aka Bujka posing with his puppy for the photo op outside his house.
©UNICEF Mongolia/2017/ Mungunkhishig Batbaatar

“Thank you, doctor! See you next time, doctor!” politely says 4-year-old Bujka while a local nutrition counsellor is readying up to leave after her weekly house-to-house visit. Living under the poverty line in one of the poorest neighborhoods in the nation’s capital, Bujka kept getting sick and was hospitalized four to five times every year until 2016. Although he has never attended kindergarten due to his health conditions and familial concerns, Bujka optimistically says “This year I won’t be sick… And I will never go back to a hospital again.” 

Bayarmaa, along with her children Tsetsegdari, Anudar and Bujka, sitting in their living room.
©UNICEFMongolia/2017/ Mungunkhishig Batbaatar

Bujka, whose real name is Bujinkhuu, lives with his parents and two older sisters in Bayanzurkh district where it has the highest under-five mortality rate, the biggest risk of communicable diseases and the largest number of ger dwellers, those who live in traditional tent-like housing on the edge of Ulaanbaatar. His mother Bayarmaa works at a local bath house since the khoroo or sub-district has no access to improved water, sanitation and hygiene (WaSH) facilities available at home. 

“All of this is quite new to me” explains mother Bayarmaa. Her tiny house made up of bricks and mostly woods is just enough for the family. Her daughters Anudari, 12, and Tsetsegdari, 10, take care of their baby brother Bujka while their parents work during the day. “I didn’t know how important it is to enrich the food we give to our children or how simple act of properly washing hands could prevent them from getting sick. That’s why, all three of my children have had health problems in the past” said Bayarmaa. Then she received nutrition advice from the FHC volunteers as a part of UNICEF supported Infant and Young Child Feeding programme. She also received micronutrient supplements for her children as well.

Community members unite against malnutrition in 17th khoroo, Bayanzurkh district

The local Family Health Center (FHC) in the community provides health services to 11000 people, making it one of the FHCs that has the largest catchment population. Furthermore, every household in this area lives in a ger district. That’s why, community health volunteers were recruited and trained as an effort to strengthen their health care delivery because a total of 16 FHC staff was not enough to reach those in need.

Mother Bayarmaa, along with her son Bujka, takes a look at their monthly progress on a health journal
prepared by the local nutrition counselor.  ©UNICEFMongolia/2017/ Mungunkhishig Batbaatar

Bujka is one of 725 children whom are identified, as having critical needs for nutrition support and services, by the FHC. UNICEF has supported the health center by providing a series of trainings for health care workers and volunteers to improve their knowledge and understanding of child nutrition. Following the training, counseling on maternal and child nutrition has become part of routine health services in the community. Moreover, UNICEF supported the establishment of Nutrition Counselling Rooms in several health centers in the district. These facilities provide a space for parents to receive counselling, and to learn how to cook micronutrient enriched food for their children.

As a result of regular house-to-house visits by local volunteers and peer support group created by the mothers who completed some of the trainings, FHC reports that whopping 90.4 per cent of the children take their multiple micronutrient powder (MNP) regularly. This figure was only 47.4 per cent prior to UNICEF-supported interventions - training, job-aide, supportive supervision and mentor opportunities to the health workers, counselling on infants and young children feeding, demo sessions to the caregivers, awareness-raising and community engagement campaigns through volunteers and peer support group mentioned above.

4-year-old Bujka at home in Bayanzurkh, Ulaanbaatar. ©UNICEFMongolia/2017/ Mungunkhishig Batbaatar

“For parents who have children under the age of 5 years old, we organize a cooking training to help them prepare nutritious meal for their children with simple ingredients. UNICEF has provided us with the cooking materials and kitchenware. It is amazing how we can achieve so much with a little help from the community.” explains Dr. Ankhtuya, the head of the FHC. Then she added “Our Bujka is a very good boy. He takes his MNP-enriched meal regularly. We sometimes request his excellent demonstration for other children who seem to dislike the food at first during trainings.”

“The biggest achievement so far is that there is no under-five mortality this year (knocks on wood), as compared to the 11 cases recorded in 2016. And, we observed a significant decrease in morbidity as a result of the WaSH and nutrition interventions in our community” carefully explained Ms. Munkhtuya, a social worker. 

From local level to nationwide implementation

Well-nourished children are able to grow and learn better, to participate in and contribute to their communities, and to be resilient in the face of disease. Proper feeding of infants and young children can increase their chances of survival. It can also promote optimal growth and development, especially from birth to 5 years of age.

“Mongolia has achieved a lot in improving nutrition of children. Underweight prevalence has dropped by 90% since 2000. However, deficiencies of vitamins and minerals as well as stunting remains key nutritional problems. Stunting level of children from wealthy households is 6%, while the figure is three times high at 19% for children from poor families” explains UNICEF Mongolia’s Nutrition officer Munkhjargal.

To address this gap, UNICEF’s nutrition program focuses on children under the age of five, and pregnant and lactating mothers of the poorest and hard to reach rural and peri-urban populations like that of 17th khoroo, Bayanzurkh district in Ulaanbaatar. The program focuses on evidence-based interventions including support for breastfeeding, and micronutrient supplementation for mother and children. These investments in nutrition – particularly at the earliest years of life – can yield dramatic results for children, their families, and communities.

“Our interventions have been very effective. According to local health statistics, the prevalence of stunting declined by 1.6 % in our programme areas compared to 2014. Recognizing its effectiveness, the Ministry of Health and Sports adopted the interventions as key component within the National Maternal and Young Child Nutrition Strategy 2015–2020 for nationwide implementation” Ms. Munkhjargal added.

Written by
Mungunkhishig Batbaatar

UNICEF Mongolia