13 February 2014: Treating Malnutrition in Zanzibar
By Sabine Brandenburg and Kamugisha Eliphase
West district, Unguja island, Zanzibar, United Republic of Tanzania, 13 February 2014
Two months after Nasra was born, her mother died. As her grandparents could not take good care of Nasra, a close relative of the family, Mwenda, aged 18, and her mother, decided to adopt her. When Nasra turned six months, she started showing signs of malnutrition. She was weak and could not cry out loud. Mwenda took Nasra to the nearest public health care unit; Kiembe Samaki, in the West District of Unguja, Zanzibar.
Like hundreds of thousands of other Tanzanian children affected by illness, Nasra lacked adequate complementary food and access to clean water. In Tanzania, it is estimated that 1.3 per cent of children under five are severely malnourished. In 2014 it is expected that there will be more than 220,000 children with severe acute malnutrition and 380,000 children with moderate malnutrition in the country. In Zanzibar, 12 per cent of children under five are suffering from acute malnutrition and 4.5 per cent are severely malnourished. In 2014, it is estimated that 40,000 children under five will be affected by acute malnutrition, of which 21,000 will be affected by severe acute malnutrition in Zanzibar.
Prevalence of high levels of under nutrition is related to multiple factors including maternal under nutrition, inadequate infant and young child feeding practices, repeated infectious diseases, poor sanitation and hygiene, as well as low capacity of health staff and community health workers to deliver nutrition information and services, and low investment on nutrition at community level.
Public health care facilities in Zanzibar
Today, all hospitals and primary health care units in Zanzibar are equipped to provide treatment of severe acute malnutrition. On top of that, 15 Community Health Workers per village regularly screen children under five for malnutrition and, if necessary, refer malnourished children to nearby facilities.
At Kiembe Samaki health care unit, Nasra was referred to an outpatient therapeutic programme, where Mwenda brought her for bi-weekly checks on weight, upper-arm circumference and signs of fever and was given supplies of high-protein, peanut paste-based therapeutic food, also called ‘Plumpy’ Nut’. Mwenda believes she is blessed for the good treatment Nasra has received from the nurses at the public health unit. “Nasra is starting to gain weight and has better appetite”, says Mwenda. “She is laughing again and shouting out loud, something she couldn’t do before”.
Today, Nasra is two years old. Mwenda and Nasra only visit the unit once a month to monitor and control Nasra’s growth. Mwanajuma, a nurse at the public health centre of Kiembe Samaki, still remembers Mwenda’s first visit. “Mwenda brought Nasra to the unit. Her weight was so low that her situation was critical. I immediately took care and treated her with all my heart. I feel so grateful that we could save this child”. With the necessary equipment, products and knowledge, provided through UNICEF, Mwanajuma was able to treat and save her life.
Strengthening joint efforts
Joint efforts are required to improve public health sectors on community based identification, referral and follow up of malnourished children cases. The public health care unit Kiembe Samaki is part of a programme called Integrated Management of Acute Malnutrition (IMAM). The programme was introduced in Zanzibar in 2009. It includes the development of IMAM guidelines and respective training packages. The Japanese National Committee for UNICEF has played a significant role in supporting the government of Tanzania and the UNICEF Country Programme to scale up IMAM in Zanzibar.
“UNICEF supports Zanzibar’s Ministry of Health to accelerate the roll-out of the IMAM programme so that all community health workers and health staff are trained to identify, treat and save children like Nasra,” says UNICEF Tanzania’s Nutrition Manager, Biram Ndiaye.
Nasra’s nurse, Biubwa, is positive. “With our help, children will be well-nourished and are more likely to be healthy. They will have an opportunity to grow and develop to the fullest. I hope to see Nasra going to school and growing up in a normal environment. She now has a future and can become a doctor, a nurse or even the future President of the country’, says Biubwa.