Ready-to-use therapeutic food helps children fight malnutrition
Community management of acute malnutrition
A few minutes before 9 am, a group of women with babies strapped onto their backs stand in a line under the shade of a mango tree at Chikole Health Centre.
The women are exquisitely dressed, as are their children, some of whom are crying for attention. They have gathered for an outpatient therapeutic programme (OTP) and growth-monitoring session for children under five years.
Three health surveillance assistants (HSAs) emerge from the main building of the health centre, and one of them hangs a weighing scale from a tree branch as the others take the group of women through basic lessons about nutrition and care for the children.
At the end of the session, the two groups of women and their children are separated. Others go for OTP and others for growth monitoring.
One of the women in the OTP group is Patuma Asima, who attended the clinic with her grandchild, Nisha Laisa. Nisha is a year and three months old. She has been taking ready-to-use therapeutic food (RUTF) for over a month.
She developed malnutrition after her mother became pregnant again before she was nine months old.
"When I took Nisha from her mother, she was still being breastfed but only sporadically. After we got her, her grandfather bought her some milk, but it wasn't enough. As a result, she developed malnutrition," Asima says.
Another woman who attended the clinic was Alima Omali with her 10-month-old child, Brian Kassim. Her older children are 13 and five years old, respectively.
"Brian opened bowels, had a fever and a cough. He lost a lot of weight. That's when I brought him to the hospital where he was admitted to the OTP," Omali explains.
Brian is her second child affected by the condition: "My second-born was also admitted under the programme, but it took him a long time to get better."
Omali is hopeful that Brian will pull through faster than his elder sibling because he is eating normally.
"There has been a change since he started taking RUTF. His body is coming back," she says.
The OTP is part of an initiative on community management of severe acute malnutrition. It is a Government of Malawi initiative implemented by the Ministry of Health in public health facilities to treat cases of severe acute malnutrition (without medical complications). Children admitted to the programme are treated with antibiotics, and RUTF provided with support from USAID. USAID's assistance has also been pivotal in implementing community management of severe acute malnutrition in nine flood-prone and drought districts. In Mangochi, it is being carried out in 44 health facilities, including Chikole.
Bright Kanzengo, a senior HSA at Chikole, explains that the centre conducts three outreach clinics within its catchment area where they may identify children with oedema or those who score poorly on the middle-upper-circumference (MUAC) test.
"We also use care groups. We taught 198 cluster leaders how to identify cases of malnutrition in children. If they identify any child with malnutrition, they refer them to the health centre or take up the issue with HSAs," he says.
The health centre conducts a series of tests on the referred children to assess if they can be treated at the centre as outpatients or should be referred to the nutrition rehabilitation unit (NRU) at Mangochi District Health Office (DHO).
"If they are no complications, we then admit them into the OTP ," he says.
He also says the health centre normally records more malnutrition cases from October to March during the lean season. The cases reduce between April, May, and June because people would have harvested their crops.
"But this year has been different because we registered 19 admissions in April and May, but our average is usually 12," he says.
He attributes the rise to increased awareness and screening after the health centre took care group promoters and cluster leaders through training on identifying and reporting suspected cases.
Chifundo Rambiki, UNICEF Nutrition Field Monitor, observes that during the lean period when most households run short of food, cases of acute malnutrition tend to increase, considering that there are no supplies for children with moderate acute malnutrition (MAM). Hence, children with MAM, particularly those whose parents or caregivers cannot afford food, regress into severe acute malnutrition (SAM), some of whom may have recovered from SAM treatment. "UNICEF works closely with government to facilitate the linkage of children suffering from malnutrition to other safety-net programmes such as food distribution and cash transfers. Community structures like care groups enable caregivers to attain skills on good nutrition and child care practices to help them safeguard the nutritional status of their children," Rambiki says.
