As ALIMA (The Alliance for International Medical Action) continues to work to increase the capacity of health workers throughout sub-Saharan Africa, specialized training schools are now providing practical, on-the-job training for doctors and nurses to improve treatment for children hospitalized with severe acute malnutrition (SAM) with complications.
Children suffering from SAM with complications, including malaria, respiratory distress and anemia, require highly-specialized care in order to improve their chances of recovery and survival. Despite national protocols to address the issue of acute malnutrition, in many countries there remains some serious training gaps in the regular academic curriculum. As a result, health care workers often lack the knowledge and competencies required to properly diagnose and treat patients with SAM.
Across West Africa’s Sahel region, UNICEF estimates that more than 1.6 million children are at risk of SAM this year, due, in part, to food shortages, following poor harvests last year. As many as 20% of these children will require hospitalization because of complications.
“Nearly 100% of patients with severe acute malnutrition and medical complications who don't receive quality care will die.”
- Dr. Kanta Malam Issa, ALIMA’s former Head of Mission in Mali, during an interview with the Emergency Nutrition Network
To help better care for these children, ALIMA, along with its local partner AMCP (Medical Alliance Against Malaria), has been implementing what is known as the URENI-school (Intensive Nutritional Rehabilitation and Education Units) model, since August 2015 in the Koulikoro region of southern Mali.
Over the course of 3 weeks, groups of up to 12 health workers are brought to the Diolia hospital, where they participate in both theoretical and hands-on training modules. In the classroom, the curriculum covers topics such as screening, detection and diagnosis, and the care and case management of SAM with complications.
At the same time, trainees shadow health staff in the hospital, where they have the opportunity to observe and practice the different treatment methods.
As of April 2018, nearly 400 health workers have completed the URENI-school training in Mali.
Fatimata Sangaré, who came to the Diolia URENI-school from her post at the Kigna Referral Health Center in the Sikassou region of Mali, where they recently opened a nutrition ward, shared her experience:
“The conditions are quite difficult because this region lacks resources. The hospital suffers from long power cuts each day, and the generator can only be turned on for emergency Cesarean sections. This means children must be manually ventilated.
During my training, I learned a lot, including how to insert a nasogastric tube, or take a blood sample.
I hope that the material conditions of my hospital will improve so that I can to put into practice everything I have learned in Diolia.”
In Chad, a similar school, known as the UNT-Ecole ( Nutritional Therapeutic Unit School), was opened in March 2017 by ALIMA, along with its local partner Alerte Santé, to train health workers using the URENI-school model.
Chad also suffers from high rates of acute malnutrition. In 2017, nearly 4% of children were severely malnourished, according to UNICEF. This is well above the emergency threshold. During the peak of the hunger season in 2017, ALIMA/Alerte Sante was admitting nearly 700 children into their malnutrition programs in N’djamena each week. At the China-Chad Friendship Hospital intensive care unit, the bed occupancy rate exceeded 200%.
To date, 144 health workers, including 13 doctors and 59 nurses, from four health districts throughout the capital, N'Djamena, have received 5 days of theoretical training, followed by 3 weeks of practical training at either the China-Chad Friendship Hospital or one of 4 nutritional treatment centers supported by ALIMA/Alerte Sante.
In Nigeria, ALIMA, in partnership with the University of Maiduguri Teaching Hospital (UMTH) and UNICEF, began using the URENI-school model in November 2017 in Borno State. The training school is the first of its kind in Borno State, where some 250,000 children are at risk of SAM, amid ongoing conflict by Boko Haram.
“Our goal is to build the capacity, and increase the skills and knowledge of health workers, including doctors, nurses and nutritionists, in order to increase the efficiency and effective day-to-day running of stabilization centers across Borno State. Up until now, there have only been small training seminars here and there.”
- Professor Jose P. Ambe, head of pediatrics at UMTH and the coordinator of ALIMA’s Intensive Therapeutic Feeding Center.
More than 50 health workers have benefited from the training school at the UMTH/ALIMA ITFC, which serves as a referral center for five health clinics in the Maiduguri area and is equipped to take on the most complicated cases of severe acute malnutrition. Thanks to care from specially trained doctors and nurses, nearly 95% of children admitted with SAM with complications survive.
“The opening of this school is really quite exciting. As nurses, our first goal when caring for patients is to help them get better. But, unfortunately, SAM treatment isn’t necessarily emphasized in school, so it can be difficult. Now, the fact that I will be able to transfer knowledge and skills to people who are in the same position I was a few months ago, and who can then train others, will really improve patient care.”
- Lincoin Egbu, an ALIMA nurse at the UMTH ITFC, who assists with the URENI-school trainings
The URENI-school projects in Mali, Chad and Nigeria have been made possible thanks to funding from the European Commission's Humanitarian Aid and Civil Protection department (ECHO), the United Nations Children's Fund (UNICEF), The United States Agency for International Development (USAID), the Office of U.S. Foreign Disaster Assistance (OFDA), the ‘Comité interministériel d'aide alimentaire’ (CIAA) and the ‘Agence Française de Développement’ (AFD).
© 2026 ALIMA
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