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 children under the age of 18 years in Uganda.
Having lost her mother to HIV/AIDS at two months and having been abandoned by her father who thought she too was HIV-positive, Jane Tibaga’s childhood was not rosy.
Despite all the bumps and bends, Tibaga’s grandmother stood by her.
“Her father dumped her here and disappeared after her mother died of HIV. Tibaga was sickly, had no appetite and her hair was scanty and brown. She also had a swollen tummy, which made me believe she too was HIV-positive,” her grandmother recalls.
“With no means to look after her, we waited for God to take her. We had no money to feed or treat her. I went to a friend who advised me to take her to hospital where, upon examination, the doctor said she was severely malnourished.
“All tests, including one for HIV, came out negative. She was started on RUTAFA, a ready-to-use peanut-based paste for treatment of acute malnutrition. Today, Tibaga is a healthy, cheerful girl,” her grandmother says. Surprisingly, she says, the girl’s father now wants to take her, which she has refused.
The old woman has since started growing vegetables and fruits in her backyard.
“I bade farewell to malnutrition and hunger. I also have excess vegetables and fruits for sale. I can also prepare a balanced diet, thanks to the STRIDES village health teams,” she adds.
What does STRIDES do?
STRIDES for Family Health is a USAID-funded project that works with the Ugandan Government to lower maternal and child mortality.
With the health ministry, the project provides reproductive health services like family planning, child survival, nutrition and treatment for malaria.
STRIDES is working to increase contraceptive use through teaching communities the benefits of proper spacing of pregnancies.
Children need special care because before they make five years, their bodies are not strong enough to fight against the common diseases of respiratory infections and diarrhoea. The baby’s first month of life is crucial for survival since nearly four out of every 10 infant deaths occur within the first month,” explains Ahmed Luwangula, a senior nutrition officer.
Many pregnant mothers do not go for antenatal care; with only 47% honouring the four WHO-recommended visits, and only 42% of births attended by skilled health personnel.
“This puts them at a higher risk of giving birth to underweight or unhealthy babies with chronic illness,” Luwangula notes.
He adds that many mothers end up dying during childbirth due to failure to recognise life-threatening conditions, delays in seeking help; delays in reaching a health facility; and delays in receiving proper care, which also affects the children’s health.
Tadeo Atuhurra, a senior communications specialist at STRIDES, says during a baseline survey in the 15 districts in which we operate, we discovered there was a direct link between malnutrition, maternal and infant mortality and a lot needed to be done to improve the situation.
“We started by organising people within their communities and teaching them proper ways of feeding,” he says. The survey was carried out in Bugiri, Kalangala, Kaliro, Kamuli, Kamwenge, Kasese, Kayunga, Kumi, Kyenjojo, Luweero, Mayuge, Mityana, Mpigi, Nakasongola and Sembabule districts.
STRIDES staff started teaching mothers about the proper ways of breastfeeding since most mothers in these areas did not know the value of exclusive breastfeeding and antenatal care.
“Most mothers stopped breastfeeding when their babies were less than a year old, while others introduced babies to food even before they are six months old. This exposed the babies to a high risk of malnutrition, diarrhoea and HIV.
Health experts say breastfeeding a child in the first two years, and exclusive breastfeeding in the first six months of life could save 1.3 million children, which many residents in Kayunga did not know,” explains Jennifer Nabukalu, a health worker and nutritional focal person working with STRIDES Kayunga.
“STRIDES also discovered that many people who were grappling with malnutrition had large families that they could not look after. Some homes had seven to 15 children, yet the rates of poverty were high. We introduced birth control methods as a way of tackling this problem.
“We teach couples about family planning. We tell them success stories of people who have small families and this has helped change their misconceptions,” Atuhurra explains.
With sensitisation, people started visiting health facilities and with STRIDES’ support, undernourished children are monitored and given supplementary foods. The health workers also teach parents about dietary needs in all the 15 districts.
Kasfa Wakoli almost died at six months and her mother, Agnes Namukasa, thought her daughter had been bewitched by a neighbour.
“When my child started losing weight, I thought she had been bewitched. I hopped from shrine to shrine and all I was told was that my neighbour was responsible for my baby’s ill-health. When STRIDES visited my home, they told me she was malnourished.
“I was advised to take her to Kayunga Health Centre IV and that is how she survived and started gaining weight. I advise people to make hospitals their first resort,” Wakoli says.
STRIDES also discovered many people had food, but did not know how to prepare it properly. They started community health sessions where people converge to learn proper methods of food preparation. They were taught how to prepare ekitobero, a mixture of different foods with different nutrients to boost children’s immunity.
The sessions also involve members composing songs and drama pieces to teach others proper nutrition and preparing balanced meals, as well as growing foods to fight hunger and malnutrition.
Members also learn about hygiene practices like washing hands before feeding babies, bathing, washing clothes, having clean places of convenience, garbage pits and a clean home environment.
They are also taught how to behave at homes to be able to bring up their children well.
“We discovered that many cases of malnutrition were caused by poor sanitation and family conflicts. Men abandoned their homes, leaving the mothers to cater for the children single-handedly. The health sessions introduced by STRIDES have greatly improved the conditions in my area,” says Charles Waiswa, the Kamuli district health inspector and nutrition focal person.
The programme has benefited over 1,700 people.
Findings about malnutrition
According to the World Health Organisation, malnutrition is the biggest contributor to child mortality, present in half of all cases. Six million children die every year due to underweight birth and hunger. Poor or non-existent breastfeeding causes another 1.4 million deaths. Other deficiencies such as lack of vitamin A or zinc, for example, account for one million deaths. Malnutrition in the first two years of life is irreversible.
The Uganda Demographic and Health Survey 2006/11 statistics indicate that half a million pregnant and nursing mothers suffer from anaemia, mainly due to poor nutrition. The country loses 13 mothers every day due to pregnancy-related causes, and half of them to nutrition challenges.
About 2.3 children below five years are stunted, while 250,000 children suffer from severe acute malnutrition. About 360 children below five years die every day and the main causes of death include acute malnutrition, malaria, acute respiratory infections and diarrhoea, which are all preventable or treatable. Nutrition interventions could save at least 120 children daily.
Overall, the country loses about sh1.8 trillion, about 5.6% of its gross domestic product, as a result of child poor nutrition.
Do you know any individual or organisation focusing efforts on improving nutrition in communities? Write to the Features Editor, P.O. Box 9815, Kampala or e-mail email@example.com giving name, telephone contact of nominee and reasons for nomination. Type food, the nominee’s name and SMS to 8338