Assistant Nurse Tangiza Tangiza believes change is possible

Across DRC, approximately six million children suffer from chronic malnutrition. This contributes to the prevalence of stunting, which often has devastating consequences on the cognitive development of children, impacting their future health outcomes negatively. 

Tangiza Tangiza, who is an assistant nurse at Katembo Health Center in Kitangua Health Zone of Kasai province, has seen hundreds of children in his community suffering from chronic malnutrition. Some repeatedly come in to receive treatments of Plumpy'Nut only to relapse when the treatment has finished. Kholoma Fandji is one of the patients that he has seen return again and again. 

At four years old, Kholoma has spent half of her life chronically malnourished. She first fell ill two years ago, soon after her father’s departure to Angola. Her family took her to the health center, and she received her first treatment of Plumpy'Nut. Since then, she has been stuck in the same cycle of recuperation and relapse: when on Plumpy'Nut she gets better. As soon as the treatment ends, she relapses into malnutrition. 

Each day, Kholoma's older sister accompanies their mother to the field, which is an hour away, leaving her four younger siblings to fend for themselves, often with no food until they return late in the evening. She says, “My father went to Angola. He's already been gone almost three years, we suffer to eat, we don't have food. Diseases contaminate us, and we have no one to look after us.”

Nyange Mayimbi fears a similar fate for her children who have recently recovered from severe malnutrition. Since Nyange Mayimbi’s husband’s death from a snake bite in 2023, she and her family have suffered. She says, “To feed the children, it's really a very big difficulty. We have a lot of suffering. I have no support. I don't have uncles or a father anywhere else. My father and mother are all dead. I'm all alone.”

Soon after her husband’s death, two of her children, Marile, age four, and Shitema, age three, fell ill. They were coughing a lot and had fevers. She took them to the health center where they were screened and diagnosed with malnutrition by health staff who were trained by the Multisectoral Nutrition and Health (PMNS) project. The health staff prescribed one week’s ration of Plumpy’Nut, a ready-to-use therapeutic food purchased by the PMNS project, which included three servings per day. For the past four weeks, Nyange has been returning weekly for screenings and another week’s ration of Plumpy’Nut. She says the children are now nearing the end of their treatment, and she has seen a change. The challenge will be to maintain their health after the Plumpy’Nut treatment has ended.

Nurse Tangiza says, “All you need to do is raise awareness, repeat. This is what we are doing, raising the community awareness so the community can take care because the Plumpy’Nut won't last forever. The Plumpy will end. The community must know that they can have gardens at home. People should know that even in those Plumpy’Nuts, it is our own food that they bring us in Plumpy’Nut. Because if we check in Plumpy’Nut, there are peanuts. There is maize. There are beans. It's the food that we produce ourselves here in our community. It’s being manufactured and brought back to us. That's why we're always strengthening awareness—for community-based nutrition.”

Fortunately, for Nyange Mayimbi’s children, Tangiza’s sentiment is reflective of larger change happening in Kasai. Tangiza is one of hundreds of community health workers recently trained as part of the implementation of the Community-Based Nutrition Initiative, known locally as NAC, which in French stands for Nutrition à Assise Communautaire. This past July, trainings took place across Kasai, arming hundreds of community-elected nutrition representatives with the knowledge and tools they need to combat malnutrition once and for all in their communities. Training community relays constitutes the second of seven steps villages across Kasai are taking to certify themselves with the capacity to sustainably manage malnutrition themselves. When the training phase has completed, more than 14,000 community health workers will be spreading the same message as Tangiza and implementing the seven-step process of NAC certification.

Villages must complete each of the seven steps before receiving their certification in community-based nutrition.

 1. Organize the community into community participation bodies where the community elects its own representatives in the form of community relays (RECOs) and community health committees known locally as CODESA members.

2. Strengthen the capacity of elected representatives through trainings.

3. Diagnosis with the community through focus group discussions in each community to help identify community-specific causes of malnutrition and how best to prevent it. 

4. Develop a plan to reduce incidence of malnutrition tailored to local context. Plans often include community sensitization and door to door screening by RECOs.

5. Implement the plan.

6. Conduct community assessments to determine how the plan is going and to assess malnutrition levels recorded in the communities.

7. Health zone staff, local community leaders, and partners assess community and certify.

Dr. Narcisse, NAC coordinator, says, “The focus groups examine what are the local causes of malnutrition within the community and, based on these causes, offers local solutions. Based on these solutions, it devises an implementation plan, a local plan to fight malnutrition.”

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IMA World Health is leading a consortium of partners to implement the Multisectoral Nutrition and Health (PMNS) project. Funded by the World Bank and managed through the Government of DRC’s Health System Strengthening Program (PDSS), the PMNS project supports the DRC’s Ministry of Health to increase access to and use of a package of community-based nutrition services and support the improvement and integration of nutrition services in health facilities to reduce the level of malnutrition in Kasai province.