By Agnes Kyotalengerire

As part of its annual series, Ugandan 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 is affecting  a big part of our population

Twenty-eight-year–old Grace Alituha sits lost in thought as she carries her emaciated baby. The two-year old can
hardly sit or stand without support. The baby’s hair is silky and thin. Her stomach and feet are swollen. Alituha says six months ago, the baby got a fever and diarrhea followed by gradual loss of weight, swelling of feet and stomach. Dr. Elizabeth Nakiboneka, the head of Mwana Mugimu Nutrition Unit in Mulago Hospital describes the baby as being wasted, which is a form of malnutrition.

Despite Uganda’s progress in reducing poverty over the years, malnutrition still ravages the country and affects millions of people in various ways. Particularly it is devastating to women, babies and children. Children under the age of five are prone to Vitamin A deficiency The latest Uganda Demographic Health Survey 2011 indicates an improvement in some nutrition indicators.

However, there is urgent need to reduce the number of stunted and wasted children. Nakiboneka says stunting can begin as early as four months. “In Uganda malnutrition cases were at the peak period usually experienced in the months of June, July and August with national emergencies carried out in areas of Namutumba (2011) and Rwamwanja in Kamwenge district (2012) resulting from Congolese refugee influx,” she says.

Nakiboneka says a recent study done at assessment centre, at Mulago Hospital revealed that cases of children under the age of five years with acute malnutrition stood at 15%.The Uganda Demographic Health Survey 2011 indicates that 33% of children under the age of five are stunted, an indicator of chronic malnutrition, while 14% of the children under five are underweight and 5% wasted.

The causes
Nutrition experts say acute malnutrition has become persistent in Uganda mostly because of poor diet and access to food due to poverty, ignorance or lack of information on what foods to eat and how to prepare them. Hanifah Namusoke, a senior nutritionist at Mwana Mugimu Nutrition Unit Mulago Hospital, says: “Children are not getting enough food and sometimes when they do, mothers do not know what foods to give and how to prepare them.” Adding that food must be clean and prepared appropriately so that the child’s body can absorb the nutrients.

She says western Uganda districts of Bushenyi and Kisoro are prominent for being the country’s food basket, but they still rank high in cases of malnutrition at 44% according to the survey by regions (2011 UDHS report). There are other predisposing factors and even in the presence of food, the chances of a malnourished mother giving birth to a malnourished baby are high.

The same applies if the children are not breast-fed enough and given complementary feeding. According to the UDHS 2011, the percentage of babies who are exclusively breast-fed stands at 63% and initiation in the first hour of birth stands at 53%. The 2012 report by Save the Children; How Overcoming Barriers to Breastfeeding Will Save Children’s Lives, estimates that 22% of the newborn deaths could be prevented if breastfeeding started in the first hour after birth. And, 16% if breastfeeding started within the first 24 hours.

Proper nutrition starts before conception, continues during pregnancy, after birth and throughout breastfeeding and complementary feeding. Namusoke says many Ugandans in rural areas lack safe drinking water and proper sanitation. These conditions lead to infectious diseases that can cause malaria and diarrhoea, resulting in severe malnutrition.

Children need to eat a variety of foods for keep healthy

Associated complications
Nakiboneka says malnutrition has immediate and long-term consequences with the immediate impact being death. Malnutrition contributes about 50-60% death in Ugandan children below five years. “Acute malnutrition may cause other health conditions like; low sugar in blood, anaemia, diarrhoea which may cause severe dehydration, skin and sight problems due to lack of nutrients,” she says.

Complications associated with Vitamin A deficiency may set in and the child may become sickly. Other micronutrient deficiency complications like lack of iron cause anaemia and consequently death. “lron is important for proper functioning of the heart and an anaemic heart may not pump blood,” she explains.

Nakiboneka says stunting, which is a long-term effect of malnutrition slows down learning since the child’s brain is fully developed by the age of two years. Namusoke says children suffering from malnutrition have a compromised immune system and are 10 times more likely to die of treatable illnesses like colds or diarrhoea, depending on which nutrients are inadequate or abundant in their diet.

Nakiboneka blames malnutrition on the high fertility rate of about six children per woman. This has resulted into mother having many children they cannot afford to care for. She says HIV/AIDS, also contributes to malnutrition in Uganda. About 15% cases in children under five years admitted to hospital are HIV-positive. Nakiboneka encourages exclusive breastfeeding and good nutrition after six months where a child is given variety of solid foods to get all the nutrients alongside breast milk.