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Uganda, September 2015: UNICEF and Government saving children from malnutrition and its effects

By Proscovia Nakibuuka Mbonye

When little Anisha was born, her mother, Sarah Mushobya, was delighted to have a baby girl. Anisha fed and grew well but when she turned ten months, the little girl begun falling sick. Because she was expecting her third child, Sarah was advised by friends to stop breastfeeding Hanisha, which she did.

Instead Anisha worsened and despite several visits to various health centres, the little girl didn’t get better. Health workers advised Sarah to take her little girl to Mwanamugimu Nutrition Unit (MNU). Sarah still recalls the day she arrived at the Unit with her child so ill, swollen and with yellow hair. Anisha was diagnosed with severe malnutrition!

“When I arrived here, my child was very sick with excessive vomiting and diarhoea, no appetite and I thought she was going to die. I had no hope,” she narrates.

Derived from a local proverb, ‘Mwanamugimu’ means a ‘healthy child.’ Mwanamugimu Nutrition Unit located at Mulago National Referral Hospital, is a rehabilitation unit that takes care of severely malnourished children. On average, the Unit receives five to seven patients a day and offers both Inpatient and Outpatient Therapeutic Care services.

According to Dr. Elizabeth Kiboneka, Director MNU, the entry point for most patients is Severe Acute Malnutrition (SAM) and majority of the cases received have life threatening complications like pneumonia; malaria, meningitis, low blood sugar, diarrhea, skin infections, all due to insufficient food. Upon arrival, all patients are screened to contain these complications that can lead to death in the first 72 hours.

In Uganda, malnutrition is an underlying cause of as many as 45 per cent of child deaths in Uganda. Malnourished children are at greater risk of infections (such as diarrhea and pneumonia), which in turn increases the risk of malnutrition.

Malnutrition also affects the growth and development of children. Therefore, the care provided at the unit includes a lot of simulation and play because many cases register delays in growth milestones. According to the Situation Analysis on Children in Uganda, not having enough nutritious food to eat does not just affect a child’s chances of survival, but can also have lifelong consequences for their physical and cognitive development, future earning power and contribution to the country’s economic development.

Prior to her daughter’s admission, Sarah, a mother of two didn’t know that a child could fall sick due to poor feeding. She believed that whatever she fed her children was nutritious. “I used to buy processed juice, sodas for my children. I didn’t know that I had to feed my children on freshly prepared food as well as feed them on different foods with different nutritional values. All this, I have learnt here at Mwanamugimu,” she adds.

“The numbers of malnourished children have greatly increased because many mothers don’t know how to feed their children. If they did, we wouldn’t have all these cases,” mentions Dr. Kiboneka. “We emphasize proper nutrition practices especially during the first 1000 days of a child’s life to mothers.”

Dr. Kiboneka asserts that what is seen at the Unit is just a tip of the iceberg. There are many untreated malnutrition cases in the communities that lead to death of thousands of children. To address this, MNU with support from UNICEF has introduced a community component in its approach to addressing malnutrition, which will ensure health workers teach mothers proper nutrition practices, identify and treat malnutrition cases early enough because the consequences of the disease are irreversible and affect children for life.

With additional support from UNICEF, MNU will train health workers from select health centres to identify, treat malnourished children as well as refer those with complications thereby reducing the risk of death from severe malnutrition; conduct physical assessments of facilities and establishment of new therapeutic feeding centres countrywide; conduct periodic technical support supervision and monitoring of Integrated Management of Acute Malnutrition (IMAM) programs in regional referral hospitals and districts implementing IMAM and also provide therapeutic feeds and nutrition equipment for use at the national referral hospital and distribution to established feeding centres.

Anisha is among the children that have benefitted from the Unit’s Inpatient Therapeutic Care programme. Upon arrival, Anisha was briefly kept in the critical care room where she was treated for excessive vomiting and diarrhea. She was then transferred to the stabilization and transition wards where she was given therapeutic milk every two hours and later on started on Ready-to-Use-Therapeutic Food (RUTF) which have enabled her regain her glory. She was later transferred to the rehabilitation ward were mothers are sensitized on the benefits of feeding children on a balanced diet, the nutritional values of various food, preparation of highly nutritious food also locally known as ‘Kitobero’ using locally available foods, proper hygiene practices, benefits of kitchen gardens where they can grow vegetables and the importance of starting up income generation activities to supplement on their incomes.

“When the children are fed on the highly nutritious therapeutic milk (F75 and F100) and the Ready-to-Use-Therapeutic Food (RUTF), provided by UNICEF, they recover very fast,” mentions Sister Justine Eytaru who has treated Anisha, since she arrived at the Unit.

“But now all that is in the past. The doctors have fed my child, treated her and she can now laugh and play,” says Sarah Musobya who was all smiles because her child was now better and they were going home. Sarah leaves the Unit with a lot of information on nutrition but what stands out is the fact that she knows when, what and how much to feed her children. “I will never let any of my children fall sick again due to poor feeding. None of them will ever become swollen again,” she says with a wide smile, urging mothers to feed their children on a balanced diet for them to grow well.



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