By Andrew Masinde
New Vision will, until October 3, publish articles on individuals and organisations that have dedicated their efforts to fighting malnutrition in the country, a problem that affects up to 54% of children under 18 in Uganda
Maria Yeno sits on a mat in the hospital ward, all her attention turned to her son whom she is trying to feed. The child, who is lying motionless on her laps, looks emaciated; with pale and wrinkled skin, sunken eyes and scanty hair that bears a golden brown hue.
Yeno, who hails from Matany sub-county in Napak district, is one of the many mothers whose children are admitted to St. Kizito Hospital Matany Referral Hospital’s Therapeutic Feeding Centre with severe malnutrition. Yeno’s son looks wasted and when he cries, his voice is faint. “He is now regaining his energy; when I brought him here he weighed three kilogrammes and he was almost dead. I now have hope he will survive,” Yeno says.
As the only hospital providing affordable services to the poor in this part of the country, the numbers of patients that flock the therapeutic feeding centre is overwhelming as the area has the highest rates of malnutrition in the country. The hospital, which belonging to the Catholic Diocese of Moroto in north-eastern Uganda, is a private not-for-profit institution, with social and spiritual objectives.
It was built to provide quality health care to the people of Karamoja and since then it has provided an essential comprehensive package of medical services to the population of the region. The hospital handles severe cases in the wards that involve children, some of them hardly 10 years old, taking care of their malnourished siblings because their parents cannot do this task as they have more children to fend for at home.
Over 40 out of the 375 children who were being treated for malnutrition at the centre in 2011 are said to have died, while 22 escaped from the centre, according to Ngiro Martin, a health educator for Napak district, who is attached to Matany Hospital.
Given that the area is semi-arid, Karamoja is always prone to famine leading to persistent malnutrition challenges.
The poor road network and the remote settlements make healthcare delivery a major challenge. Because the villages are remote, families seeking treatment for their malnourished children have to trek long distances to hospitals, food distribution points, therapeutic feeding centres or nutrition units.
In Karamoja, women are the major bread earners, while men go hunting and looking after cattle. The hospital is a first referral health facility for the entire Karamoja and the neighbouring districts of Amuria and Katakwi in Teso region.
On average it receives more than 12,000 in-patients and 45,000–50,000 outpatient annually,” Günther Naerich, the chief executive officer of the hospital, says.
He adds that many people in the area continue to experience food insecurity due to harsh weather conditions often characterised by extremely dry weather and some years, heavy rainfall, leading to poor harvest. Naerich says malnutrition has found a suitable home in this community mainly because of bad weather. “This has resulted into food shortages and reduced number of cattle due to cattle rustling in the past years,” he explains.Naerich adds that the major challenge is that people look at malnutrition not as a deficiency but as a curse as most people are illiterate.
According to Food and Nutrition Technical Assistance II (FANTA-2) (1998-2008, 2008-2013); Karamoja region suffers one the worst rates of malnutrition in the world. In 2010, 16% of children aged below five suffered from acute malnutrition and nearly 40% of children in this age group were underweight.
“At household level malnutrition is linked to women having such a heavy workload that they cannot provide quality childcare.
Poor sanitation, hygiene, frequent pregnancies and poverty caused by lack of livelihood alternatives are other contributors,” Naerich says. Martin Ngiro, a public health worker says: “People continue to tussle with the impact of shocks and other vulnerabilities that affect their nutritional status such as the loss of cows to rustlers and climatic change.”
He adds that despite the high illiteracy levels in the past, the people had cows which were source of their livelihood. “Children of school-going age were not in school, but they would loiter naked and happy because they were well—nourished. Drought was on and off, but cows were there to provide milk, meat and butter,” he explains. Ngiro says the community had a strong culture of communion and good values that promoted healthy practices like breastfeeding, child spacing and nutritious traditional foods for children and adults.
Role of the hospital
The hospital distributes emergency relief food to patients. However, this is not enough, so they have to teach the people how to grow food; but the harsh climate and poor harvest makes their efforts difficult to sustain. “Through the village health teams the hospital is trying to tackle this problem by teaching the communities to avoid over-consumption of alcohol as this is the reason malnutrition is on the increase; people sell food to buy alcohol.
This, however, has reduced and people are now going back to the granary system of storing food,” Ngiro says. The hospital also started an antiretroviral therapy clinic. They counsel people living with HIV/AIDS, follow them up to their homes and encourage them on positive living and drug adherence.
They also support people with HIV/AIDS and TB by giving them a monthly food ratio and other basic items including home-based care, which helps them adhere to treatment. The hospital has also tried to eliminate-mother-to-child transmission of HIV by teaching mothers who come for antenatal care, thus reducing the number of children born with HIV. Other lessons taught include exclusive breast-feeding for six months.
The hospital also provides food to all patients admitted and prepare special diet for malnourished children and other patients who have no caretakers. The mothers are then taught how to prevent malnutrition. In the 2012/13 financial year, 378 children received nutritional and medical support
Sustaining the malnourished children
The hospital conducts monthly reviews by way of sensitisation and paying regular visits to the communities. It also encourages mothers to come with their husbands for antenatal visits. Once the malnourished children are discharged, the mothers are linked to their respective health centres where they receive food supplements until the children fully recover and attain the required weight.
One of the children waiting for food at the hospital
Why malnutrition persists
Many mothers see admission of a malnourished child as a waste of time since they have to work to be able to feed their families. For this reason, many of them escape from the hospital before the situation improves. Tackling malnutrition in the area requires a well-designed programme that deals with the problem from the causes rather than the symptoms.Alcohol business in this part of the country is booming, leaving no time for adults to work in their gardens.
Widespread poverty, empty granaries and uncontrolled alcohol consumption worsen the malnutrition problem, as people who are addicted to alcohol sell even the little food there is, leaving their families with nothing to eat.
Maruk Achia from Locholi in Matany sub-county, Napak district, almost lost her daughter due to malnutrition, which she first blamed on evil spirits. “My child was healthy, but started falling sick suddenly, with constant diarrhoea.
A friend advised me to take her to hospital where she was diagnosed with malnutrition. They started giving her milk and nuts that improved her health. “I was advised that I give her milk regularly. I also learnt how to grow food. Now my child is healthy and I have food at home, thanks to Matany Hospital,”Achia says.