In the battle against malnutrition in Malawi, community outreach is making all the difference
By Victor Chinyama
Anna Jumbe did not understand why her 14 month-old baby was always sickly. Fed up with the various treatments she had administered, none of which worked, she decided to walk 10 kilometers to Chiwamba Health Center where her baby Brenda was diagnosed with acute malnutrition and admitted into the Nutrition Rehabilitation Programme.
“I have been here for seven weeks,” she said. “Now my baby is able to eat and play. She is now okay and thriving,”
Brenda, now aged two and half years, had lived with malnutrition for more than a year before she was brought for treatment. Thankfully, she is on her way to recovery but, as the Health Center’s Medical Assistant Lackson Mbowela observes, preventing malnutrition has to begin in homes and communities.
‘The major causes of malnutrition, apart from inadequate food in the home, are poor food preparation, ignorance on proper infant feeding practices, and traditional practices which forbid children from eating certain types of foods, such as eggs, for example,” he said.
This is where Health Surveillance Assistants (HSAs) come in. These are a cadre of trained, salaried outreach workers, foot soldiers in the frontline battle against largely preventable diseases that have decimated the lives of millions of children in Malawi. So far, the Government has trained 12,000 HSAs.
At Chiwamba Health Center, the 41 HSAs reach out to a catchment of 63,000 people. They visit villages twice a month, armed with a checklist asking mothers if they have enough Ready-to-Use-Therapeutic Food (RUTF) for their young children and counselling them on breastfeeding and other types of food needed for a baby to thrive.
“My work is to know their health,” says HSA Madalitso Chadewa. “How they live, do they have enough food? If they do, I counsel them to keep it up. If not, I tell them what is needed and try and find out if they can afford it.”
Chadewa fills out the information he collects on a form every month and transports it to the district health office where health officials compile it with data from all the health centres in the district and transmit it to the nutrition unit in the Ministry of Health. Staff at the ministry manually enter the data into a spreadsheet for analysis. The process is laborious, time-consuming and prone to numerous errors.
An evaluation of the surveillance system undertaken in 2007 showed that many errors occurred during the data collection and data entry stages. Correcting these errors resulted in delays of 2 to 3 months and undermined the very essence of a surveillance system, which is to provide timely information for the early warning system to ensure appropriate actions are implemented in time to save lives.
In 2009, UNICEF, in collaboration with Columbia University, supported the Government of Malawi to pilot the use of rapid short message service (SMS) for transmitting nutrition data in three sentinel sites. RapidSMS allows for real-time data entry, analysis and graphing, making it possible to use surveillance as an early warning tool. The technology has helped to address the shortcomings of paper-based system by implementing automated data-entry into a central database with transmission times of two minutes, as opposed to two to three months when using the paper-based system, improving data quality by reducing data entry errors from nearly 15 per cent when using the paper-based system to less than three per cent, and offering two-way information flow between the analysts at the Ministry of Health and health providers at centres such as Chiwamba.
In Malawi, as in most other countries that depend on rain-fed agriculture, household food security is largely subject to seasonal harvest. According to Anna’s husband Samson Chadza, February to March is peak hunger season when most granaries are empty as people await the next harvest in May.
“This season, we harvested 20 bags of maize,” he says. “We also have a garden where we have planted vegetable for eating and selling.”
Mr. Chadza’s 20 bags is an unusually good harvest, thanks to a fertiliser and seed subsidy programme initiated by the Government in 2005. He plans to sell some of the maize and invest in rearing chickens.
For Mr. Chadewa, his task is to ensure that Mr. Chadza follows through with his plans, for the sake of little Brenda.