By Benedict Okethwengu
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.
Vivian Ajolorwoth, 2, lives with her family in a mud-andwattle grass-thatched house in a remote village in Jupala, Kucwiny sub-county in Nebbi district. The youngest of the three children, Ajolorwoth is mainly being taken care of by her elder siblings, as her parents, who are subsistence farmers, are busy working their fields.
Ajolorwoth was underweight at birth. She was also poorly fed, resulting in recurrent illness. She was diagnosed as with anaemia and acute malnutrition at Nebbi Hospital where her parents brought her on August 30, looking pale with a high fever and breathing difficulties. Malnutrition is a serious threat to child survival and development in Nebbi.
However, many parents in this part of the country only seek medical help when their children’s situation is too critical. The fact that many parents are unaware of the causes of the condition and do not know where to seek help makes the situation even worse. “My daughter has been small ever since she was born and I thought it was normal,” says Evelyn Faumbe, 22, Ajolorwoth’s mother. “I thought she would eventually grow like my other children.
I didn’t know she was suffering from malnutrition.” A survey done in the northern region by Integrated Nutrition and Agriculture Project, a USAID Community Connector, on stunting and anaemia in Uganda indicates that by 2011 the prevalence of child anaemia in West Nile was high at 64%, the highest being Karamoja at 75%.
The Cost of Hunger in Africa (COHA) study led by African Union Commission estimated that one in every three children in Uganda is stunted. Stunting is a lifelong condition that results when children miss out on critical nutrients such as proteins, vitamins and minerals while in the womb or in the first five years of life.
According to Gloria Nabasa, a nutrition fellow at the Mwanamugimu Nutrition Unit of Mulago National Referral Hospital, people affected by stunting are more likely to suffer from fever, anaemia, diarrhoea and respiratory infections. They also have a higher likelihood of dropping out of school, being less productive at work, and spending more resources on medical care. Nabasa says children with
acute malnutrition have low resistance to infection and are more likely to die from common childhood ailments such as malaria, anaemia, diarrhoea and respiratory infections.
She adds that poor convalescence from frequent illness and poor feeding habits lock those who survive into a vicious cycle of sickness and stunting. Under nutrition, according to COHA, costs Uganda sh1.8 trillion (about 5.6% of its gross domestic product). While being treated for anaemia, Ajolorwoth was transferred to the nutrition unit, only a block away from the paediatric ward, to be treated for acute malnutrition. Here she was given therapeutic milk, and plumpy nut, a therapeutic food rich in proteins, minerals and vitamins.
After significant weight gain and improved health, she was released from the hospital after two weeks. She was provided with locally produced ready-touse therapeutic milk and Plumpy nut. Ajolorwoth who is continuing her treatment at home, is now on the road to full recovery. She is among the first beneficiaries of the United Nations Children’s Fund (UNICEF)-supported Integrated Management of Acute Malnutrition Programme initiated across the health centres and the hospital in Nebbi district.
Nelly Birungi, the UNICEF nutrition specialist, says they aim to reach out and treat more children with acute malnutrition through a combination of management at both health facilities and in the community in the district. Birungi explained that through the health centres, they give therapeutic feeds rich in proteins, minerals and vitamins for the treatment of severe acute malnutrition.
“Nebbi is one of the 21 early riser districts for Uganda Nutrition Action Plan 2011–2016 (UNAP) where multi-sectoral interventions are being rolled out to address malnutrition,” she noted. She says statistics indicates that stunting in children less than five years is at 34%, above the national average of 33% and above the acceptable limits of 20%, while underweight is at 13%.
She notes that the prevalence of anaemia in children is at about 75%, and 50% in women of reproductive age. Birungi says they have established and orientated the district nutrition coordination committees comprising eight to10 members drawn from the departments of health, agriculture, community development, education and planning to ensure that nutrition issues are included in their plans. About 150 health workers, she says, have also been trained on nutrition packages (Integrated Management of Acute Malnutrition (IMAM) and Infant and Young Child Feeding (IYCF) in Nebbi district.
Treatment centres for severe acute malnutrition have been established and equipped with weighing scales and height boards to start programmes to manage severe acute malnutrition in children in 30 health centres in the district. The fight against malnutrition requires collective approach, Birungi says, and as such, about 150 village health teams have been trained and equipped to conduct nutrition activities.
“We are supporting both facility level and community level interventions to address and improve the nutrition status of vulnerable groups like children and women using a multi-sectoral approach,” she says. “Informal groups like women, farmers, youths have been formed in each of the districts to act as change agents for nutrition,” she adds.
Kitts Ubima, the Nebbi district focal person in charge nutrition, says, in a district that has one private functional nutrition unit at Angal Hospital, the UNICEF intervention is timely. He notes that through the intervention, they are focusing on prevention as well as identifying and addressing acute malnutrition cases before the symptoms require inpatient treatment.
The health workers are asked to organise cooking demonstrations to show caregivers how to prepare nutritious foods for children from the locally available foods. They also raise community awareness on addressing malnutrition in the affected areas. Jennifer Giramia, a registered nurse at the unit, says the therapeutic food is soft, palatable and easy to use. as it requires no preparation