As part of its annual series, Ugandans Making a Difference, New Vision will, until October 3, publish articles on individuals and organisations that have dedicated their efforts to fighting malnutrition in the country. The articles will highlight the causes, discuss solutions and recognise the efforts of those working to avert the problem that is affects up to 54% of children under the age of 18 years in Uganda.
By Hope Sande
She looks pale and weak as she lies on the hospital bed at Mulago Hospital maternity ward. Allen Nandibe has had a normal birth, but is unable to share the joy because her health is at risk.
Nandibe says she did not have any complications during pregnancy, but about 30 minutes after delivery, she started bleeding profusely and was rushed back to the theatre.
Although her baby looked healthy, she cannot attend to her because she is weak and anaemic.
Paul Kiondo, a gynaecologist at the hospital, describes Nandibe’s condition as anaemia. This is a condition in which there are insufficient red blood cells resulting into low oxygen levels in the body. “She is lucky she is still alive; many deaths occur as a result of maternal bleeding,” Kiondo says.
About 50% of pregnant women in Uganda are anaemic and the condition increases the risk of death for the mother and baby during pregnancy and childbirth.
The high prevalence of anaemia in mothers and children can be attributed to poverty and limited access to nutrition and health education information.
Women become anaemic during pregnancy due to lack of iron and other vitamins, which leads to birth of unhealthy babies and excessive maternal bleeding.
One can get the necessary nutrients, especially iron, through proper feeding. Good sources of iron are meat, whole meal bread, cereal, eggs, spinach and dried fruits. During pregnancy, women are always supplemented with folic acid.
In Uganda about half a million pregnant and lactating women suffer from anaemia. Thirteen mothers die every day due to pregnancy-related causes and half of these deaths are related to nutrition problems.
Although there are interventions to maternal malnutrition, the majority of mothers do not have access to information or services.
According to the ministry of health, one in three mothers receive vitamin A supplementation after delivery, 47% of mothers attend four or more antenatal visits.
Less than 1% of mothers followed the recommended dose of 90+ IFA (Iron and Folic Acid) supplementation, 60% of pregnant women take iron supplements for 60 days or less, 16% receive IPT2 (intermittent preventive Treatment), 24% of women reported sleeping under mosquito nets and 26.8% deworm.
A cycle of malnutrition
Gloria Nabaasa, a nutritionist at Mwana Mugimu Nutrition Unit in Mulago Hospital describes maternal nutrition as nutrition of a woman at any stage of her reproductive age.
Many women in Uganda experience malnutrition either at birth, as adolescents, while pregnant or in old age. “Pregnant women do not only need nutrition for their own health, but the unborn child as well”.
Nutrition in women is a cycle; the impact of poor maternal nutrition begins before a woman conceives, through pregnancy, delivery and lactation where the cycle may resume.
Many women are undernourished at birth, stunted during childhood, become pregnant during adolescence, are underfed as well as overworked during pregnancy and lactation and consequently, give birth to underweight babies.
It is such children, who become stunted adults, perpetuating the intergeneration cycle of malnutrition.
Under nutrition weakens a woman’s ability to survive childbirth and give birth to a healthy baby, translating into increased morbidity and mortality of mothers and their infants.
Turning it around
Julie Wamala, a nutritionist at Mwana mugimu, says maternal health not only improves the mother’s health and that of her family, but also increases the number of women in the workforce and promotes economic growth and the wellbeing of communities and the country.
Around the world, a woman dies due to pregnancy and childbirth complications every two minutes. Improved nutrition may prevent some of the complications.
Lack of a balanced diet makes pregnant women weak and vulnerable to infections; results into birth of unhealthy babies and may cause excessive bleeding during child birth.
Good nutrition improves the social status of a woman and reduces maternal health risks like anaemia which is linked to excessive bleeding during and after childbirth. Anaemia is the leading cause of maternal death.
Wamala explains that child mortality can be reduced if a mother feeds well. Malnutrition is responsible for about five million child deaths globally and improving child and maternal nutrition would reduce these deaths.
Causes and consequences
In Arua, Nandibe’s home town, the health centre is far from her home, which makes her unable to go for antenatal visits which would have helped her realised her problem earlier.
She is lucky to have been visiting her aunt in Kawempe, where she was rushed to a health centre at the time of delivery. Dr. Kiondo says it is hard to handle cases like Nandibe’s in villages because of poor health facilities.
According to the health ministry maternal mortality report, there are many factors contributing to maternal malnutrition, which include inadequate maternal care, food insecurity, insufficient health services and poor hygiene and sanitation, poor access to basic health services like iron and folic acid supplements, infections and diseases.
Political structure, heavy workload, frequent birth, harmful cultural practices and food taboos and intra household food distribution do not favour women.
Maternal malnutrition increases the risk of maternal death, infections, anaemia, compromised immune functions, weakness and lower productivity.
When transferred to children, there is an increased risk of foetal death, retardation, low birth weight, preterm birth, compromised immunity, birth defects and reduced IQ.
Quantity vs quality
One of the obstacles to the provision of improved maternal nutrition is lack of comprehensive nutrition recommendations for health service providers to in guiding women on how to meet their nutritional needs.
Wamala says there is lack information; people do not know what nutrition is, what they should take and in what quantities.
“People think it is a matter of getting full; they ignore the nutritional value of the foods they take,” she explains.
What needs to be done?
Kiondo says pregnant women need to take care of their health and that of their babies. “Eat plenty of fruits and vegetables on every meal, drink enough fluids and avoid caffeinated drinks because they interfere with iron absorption and may contribute to anaemia. It is always better to drink tea or coffee an hour before or after a meal,” he says.
Before pregnancy, throughout pregnancy and for at least three months after childbirth, a mother needs iron, folic acid or a multiple-micronutrient supplement to prevent anaemia.
He also advises mothers to always use iodised salt for brain development, physical growth and to avoid goitre. Iodized salt also protects against unexplained abortions, miscarriages and stillbirths. Taking vitamin A supplements immediately after delivery or within eight weeks after delivery helps build the baby’s immune system through breast milk.
What to eat
“A balanced diet must contain all nutrients. When pregnant or breast feeding, a mother needs a balanced diet daily to get enough energy for herself and the baby.
One needs to select foods from different food categories.
Carbohydrates (energy givers) can be obtained from cereals like maize, sorghum, rice and millet and tubers like cassava and potatoes; proteins (body builders) from legumes such as beans, peas, groundnuts and simsim; and animal products (meat, eggs, milk, fish and chicken); and vitamins (protective) from fruits (mango, banana, pawpaw, orange, pineapple, passion fruits, avocado, watermelon) and vegetables (cabbage, doodo, nakatti, spinach, broccoli, lettuce, carrots, tomatoes, pumpkin, eggplant). Fats and oils are got from, oilseeds, margarine, ghee and butter.
Do you know any individual or organisation focusing efforts on improving nutrition in communities? Write to the Features Editor, P.O. Box 9815 Kampala
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Quantity vs quality: Ugandan moms caught up in a cycle of malnutrition