By Joseph Wanzusi
New Vision will, until October 3, publish articles on individuals and organisations that have dedicated their efforts
to fighting malnutrition in the country. The problem affects up to 54% of children under 18 in Uganda
Evelyn Nabalayo is just 24 years of age. Dressed in a dirty, ragged long dress, with unkempt hair, this mother of five, a resident of Bunatanga in Bukusu sub-county, Manafwa district, looks like a haggard 40-year-old woman. Nabalayo had her first-born when she was 15. Nabalayo is one of the many mothers in the area who gave birth in their teen years and are living in abject poverty and struggling to take care of their malnourished children.
With two of her malnourished children tagging her threadbare dress, Nabalayo laments: “The father of my children earns little from vending matooke. Our land is so small that we can hardly grow enough food for the family. So the children are all malnourished and sickly.”
Jane Nambuya of Bunangabo village in Bugobero subcounty is a mother of four, now carrying her fifth pregnancy. Her fourth child is malnourished. She stopped breastfeeding when she realised she was pregnant. Nambuya is full of praises for an American charity, Kissito Healthcare International (KHI), which taught her the different types of nutritious foods and how to prepare them.
The organisation, in partnership with Manafwa district health department at Bugobero Health Centre IV, has also been providing free medical treatment since 2010. Allen Mukoya, 23, a resident of Buwasiba village in the hilly sub-county of Bupoto on the slopes of Mt. Elgon, says her third child, who is now 18 months old, cannot walk due to health complications.
She attributes this to poor feeding. She discussed the issue of family planning with her husband and has, for the past three months, been using contraceptives. “I have agreed with my husband that we should not have another
baby until my child is in good health.
Even as a mother my nutrition is not good,” Mukoya added. The increasing number of teenage mothers has greatly contributed to the high cases of malnutrition among children in several subcounties of Manafwa district. Margaret Wokuri, 65, and Theresa Nambuya, 52, both residents of Bumangase village in Bubutu sub-county are carrying the burden of caring for their grandchildren. Their teenage daughters abandoned the babies and crossed into Kenya to look for menial jobs, including engaging in commercial sex. “At my age I have no energy to grow or buy nutritious food for a family.
That is why my grandchildren are malnourished forcing me to seek help from the nutrition unit at Bugobero Health Centre,” Wokuri says. At Bugobero Health Centre IV, where KHI runs a bimonthly nutrition clinic, about 50 mothers turn up with malnourished children, some of them in critical condition. Angella Abeso, a nutritionist attached to KHI, says they teach mothers and some fathers how to balance their family diet, the importance and methods of family planning, hygiene and immunisation before the malnourished children are assessed. KHI spends about sh2.5m per month on provision of foodstuffs and medicine.
On some occasions, a modest amount of money is given to those who are too poor to afford transport fare back to their homes, Abeso explains. “In our interaction with mothers, we discovered that majority of them engage in sexual relationship leading to early marriages where they give birth to children they cannot take care of. Others abandon the children with their grandparents who have no means of providing the children with a proper diet,” Abeso says.
“Every time we hold a nutrition clinic at Bugobero, we are overwhelmed by a big turn up of mothers from as far as the Uganda-Kenya border areas. However, when this nutrition programme kicked off, we were targeting the residents of Bugobero subcounty,” Abeso explains. Abeso says a nutrition team comprising nine people, who include nutritionists, nurses, a clinical officer, a public health officer, a health educator and village health team members help identify and mobilise mothers for nutrition clinics.
Over 500 clients have attended the clinics in the past one year alone, she says. The nutrition team has been carrying out outreach programmes in several villages of Manafwa district, where men and women are taught about family planning as one of the strategies in curbing malnutrition.
She says after assessment, severely malnourished children are referred to Mbale Regional Referral Hospital’s Mwana Mugimu Clinic, with KHI footing the maintenance bills for both the mother and the child until they are discharged. Abeso says plans are underway to start a mentorship programme for schools in the district to reduce cases of early marriages.
Visiting medical students from Jefferson College USA during a nutrition clinic at Bugobero Health Centre
One out of five pregnancies are among women below 20
Information from the Uganda Bureau of Statistics shows that in Uganda, by the age of 20 years, over 70% of women are already married. Almost one fifth of all pregnancies in Uganda are happening among women younger than 20 years of age which is way too early than the internationally recommended age of 29 years at first pregnancy. As a result, 12% of women are considered too thin, a situation that increases the risk for childbirth complications and underweight babies, and newborn mortality.
Dr. Gideon Wamasebu, the Manafwa district health officer who advocates the introduction of family planning services in primary and secondary schools says research shows that many of the girls in this part of the country become sexually active before the age of 15 years, but fear to approach family planning clinics, while others share contraceptive pills without being checked and counselled by a health worker.
“Nutrition education carried out by KHI during community outreaches in the district has greatly helped to screen malnourished children, who are provided with nutritious foods like millet flour mixed with soya for making porridge,” Wamasebu says.