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LuxOR Operational Research Highlights 2019/2020


In Maiduguri, MSF runs an inpatient therapeutic feeding centre (ITFC) with more than 70 beds. © Yuna Cho/MSF



    In Nigeria, severe acute malnutrition remains a serious health issue. Approximately two million children are affected every year, with only two in ten receiving treatment. In Médecins Sans Frontières’ (MSF) therapeutic feeding program in Maiduguri, a case series documents three cases of Kwashiorkor dermatosis, a severe type of skin lesion caused by a protein deficiency.


    Over 300 children are admitted to MSF’s nutrition project in Maiduguri every month during the annual hunger gap from May- September, when crops are growing, but cannot be harvested yet. Up to 13% of them suffer from Kwashiorkor, a protein deficiency causing swelling of the face and limbs, an enlarged liver, and skin lesions and ulceration called Kwashiorkor dermatosis.

    Without regular wound cleaning to ensure the healing process, Kwashiorkor dermatosis patients are vulnerable to relentless infection. They require close observation and specialized medical care, posing a particular challenge in northeastern Nigeria, a region heavily affected by conflict and lacking essential medical supplies and resources. As the disease can lighten children’s hair, parents often believe Kwashiorkor is caused by the sun, and seek help from traditional medicine, or delay medical treatment.

    In a case series documenting Kwashiorkor dermatosis in three children, a team of operational researchers supported by LuxOR described the clinical presentation and case management, and additionally explored perspectives of Kwashiorkor patients’ caretakers. Each of the children required admission with near constant monitoring and had to be cared for at the clinic for up to 38 days.

    For children with severe forms of Kwashiorkor, the case series’ key results call for a specific wound care training and treatment, and suggests for them to be observed on the same ward by a specially trained nurse. To prevent further infection, close attention to daily hygiene is equally important: changing bed sheets daily, using mosquito nets, and regularly cutting nails to avoid scratching.

    A substantial communication gap was identified between the medical team and the primary caregivers. While family and community members play a critical role in ensuring hygienic practices and appropriate nutrition at home, they were not always informed of the link between skin lesions and malnutrition. This gap is now to be closed with better health messaging and information materials for caregivers.

    Case series are a methodology to examine and document unique, highly contextual issues and rare medical conditions. Where small case numbers or a lack of sufficient data impede full quantitative or qualitative analysis, case series offer a true alternative to close knowledge gaps and shed light on prevention and treatment practices. In addition to Kwashiorkor, LuxOR-supported case series explored documented hippopotamus bite morbidity in Burundi, or bacteria infecting blood in Central African Republic.

    In 2019, LuxOR helped to develop a training initiative on conducting case series in humanitarian contexts, and continues to support thematic workshops in Senegal and Uganda.

    Engy Ali

    Operational Research Advisor

    Case series are one of the oldest forms of research. Yet in the pyramid of evidence, they rank quite low as they cannot be replicated in other research. Nonetheless, they remain valuable for education, and help us understand and document rare health issues in humanitarian settings.