By Andrew Masinde
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 affects up to 54% of childrenunder the age of 18 years in Uganda.
Brian Tumusiime spins excitedly on his knees before disappearing behind a curtain that separates his parents’ bedroom from the living room in their two-room house in Kimondo village, Bushenyi district.
Tumusiime may look like any other jolly boy, but it is a miracle he is alive. At six months, Tumusiime weighed only 3kg, was pale, had sores all over his body, constantly cried, failed to crawl and spent all his days indoors.
“We feared to bring him out of the house because we did not want to be the talk of the village. Even when visitors came to our house, we hid him behind the curtain where they could not see him,” Beth Ninsiima, Tumusiime’s mother recalls.
Unsure of what was happening to their child, Tumusiime’s parents paid endless visits to the nearby Kitagata hot springs, which is believed to be a remedy to all ailments.
Tumusiime was only saved when a peer educator from the nearby Kitagata Hospital, who was moving door-to-door educating parents on good feeding habits, bumped into him and advised the parents to take him to hospital.
They discovered what today they describe as a miracle cure. “We were shocked when the doctor told us that our son was malnourished,” Ninsiima says.
Tumusiime’s parents are convinced that their child would never have recovered had they not started him on “RUTAFA,” locally translated as “will not die”. RUTAFA is an acronym for Ready to Use Therapeutic Food, a nutritional product of RECO Industries.
Today, Tumusiime crawls and looks healthy. “Sometimes we just need people to remind us of what we are supposed to do and RECO did that,” says John Mucungunzi, Tumusiime’s father.
Like Mucunguzi, many Ugandans are suffering acute malnutrition, despite the big chunks of land and the food they produce.
It is estimated that one million children die every year from severe acute malnutrition globally, while in Uganda the condition accounts for 12% of mortality rate directly or indirectly among the under-fives. RUTAFA is made from locally sourced ingredients like peanuts, sugar, soy oil, palm oil and milk.
The product has high energy supplement foods rich in nutrients including essential minerals and vitamins that are useful in treating malnutrition.
Alex Kisembo, the RECO Industries marketing and sales director, says the is an agrobased industry specializing in the manufacture of food products such as fruit juices, concentrates, jams, marmalades and chilli.
“The company partners with USAID/UGANDA to produce nutritional products for impoverished people who suffer from a number of debilitating diseases,” Kisembo says.
RECO produces therapeutic foods that have greatly controlled malnutrition among children, pregnant and breastfeeding mothers, as well as people living with HIV/ AIDS in Uganda.
He adds that the company runs a nutrition-sensitive programme, focusing on the development and marketing of specialised food products to address malnutrition.
“Many farmers owned huge chunks of land that were idle. So we moved to the local communities through our field officers to identify these farmers and train them in improved farming methods.
"This has improved both agricultural practices to produce therapeutic and supplementary food inputs such as peanuts, maize, soybeans and household production of fruits and vegetables for consumption to improve household nutrition,” Kisembo explains.
According to Brian Rwabwogo, the chief of party for USAID/UGANDA’s production for improved nutrition, RECO implements the programme to reduce under nutrition among vulnerable groups.
The initiative has so far reached 27,000 farmers and distributes the product to 103 health facilities across 59 districts in Uganda.
“There have been a commendable success rate, improved health and positive responses,” Rwabwogo says.
Marion, an HIV-positive mother, is testimony to Rwabwogo’s assertion, “I am positive and so is my lastborn child. Due to the poor conditions, there was no hope for survival. We had nowhere to run to, we were taking anti-retroviral drugs and we were told we had to eat well.
"However, due to poverty, we could not afford good meals. I thought of killing my child because of his condition. When I visited Mbarara Hospital, I was given RUTAFA and today you cannot tell that my son and I are HIV positive," says Marion.
RUTAFA is a ready-to-use therapeutic food, which boosts the body’s immunity, especially for malnourished children or those with living with HIV.
The dietary supplements also boost immunity, especially the garlic oil and berbendite. In Uganda, malnutrition is a public health problem, with almost 48% of Ugandans having food deficiencies.
Children, pregnant women, breastfeeding mothers and people with chronic illnesses, especially HIV/AIDS and tuberculosis patients are hardest hit.
All the micronutrient deficiencies resulting from inadequate intake of minerals such as iron, iodine, folic acid, zinc and vitamins A,B,C,D and K, are a public health concern, which predisposes individuals to acute malnutrition. The foods produced by RECO deal with these nutritional conditions.
According to Agnes Baku Chandia, the head of the nutrition unit at the health ministry, ready-to-use therapeutic foods improve the nutritional status and prevent death by 55%, and, if administered early, can improve cure rates.
Chandia states that ready-to-use therapeutic foods are now on the essential drugs list, so health facilities can order for them like any other drugs.
The product is a treatment for severe acute malnutrition in children and adults as well as people living with HIV/AIDS. RECO also produces peanut butter, which is used mainly by families with young children that are looking for healthier alternatives as bread spread and also a sauce for cooking with meals.
Production of peanut butter along with hydrolysed soy protein and honey was the first step in the process of providing ready-to-eat fortified foods.
A mother feeding her child with RUTAFA supplements
RECO, encourages farmers to grow foods. Farmers are encouraged to open up backyard gardens where they grow vegetables and fruits to improve nutrition at household level.
After regaining their health, patients are encouraged to continue eating the right foods to avoid relapses. “As we give RUTAFA to the patients, we counsel and teach them about good feeding habits.
We have demonstration gardens at the hospital where we show them what to grow and assure them that they do not need huge chunks of land to keep their children healthy,” says Susan Ssenyange, a nurse at the Jinja Regional Referral Hospital’s nutrition unit where RUTAFA is administered.
Ruth Nawundo, a resident of Jinja, whose child was malnourished and given RUTAFA says: “I thought my child had been bewitched. When I was told she was malnourished, I was surprised because I thought as long as I gave her enough food, I was feeding her well.
"I was given RUTAFA and taught how to feed my child on different foods to give her energy and protect her from infections.”
The company plans to start producing fortified cassava and millet flour. They also plan to start ready-to-use supplementary foods. F-75 is the “starter” formula used during initial management of malnutrition, beginning as soon as possible and continuing for two to seven days until the child has stabilised.
They also plan to manufacture F-100 and F-75 therapeutic milk products designed to treat severe malnutrition. F-100 is used as a “catchup” formula to rebuild wasted tissues for F-75; F-100 contains more calories and protein: 100 kcal and 2.9g protein per 100 ml.
How safe are the products
“RECO products are certified by ISO 9001-2008. Uganda National Bureau of Standards quality mark, implementing environmental management system accredited to ISO14001, organic certificate issued institute for market ecology, cleaner production certificate issued by Uganda cleaner production center / UNIDO and halal so the user are rest assured of quality foods,” Kisembo explains.