Treating malnutrition on all fronts
Improving children's nutritional status
ENGELA, Namibia, 4 August 2015 - “Mama, mama,” wails toddler Ester Paulus as her mother, 25-year-old Tweumona David, holds her down on a hospital bed and a nurse slowly draws a syringe of blood from the little girl’s lower abdomen. Her sobs are heart-wrenching and Tweumona looks on, stony-faced. But underneath that veneer of coldness is a mother’s distress. Ester is only 1 year and 4 months old and her head looms large over an emaciated body. She is severely malnourished, a life-threatening condition that requires immediate medical intervention to save her young life.
As her child got sicker and weaker in their village of Okatale, which lies on the Namibian and Angolan border, Tweumona knew she could not wait any longer. She had to take Ester for urgent medical attention. But the closest hospital was Engela District Hospital, 40 kilometres away from home. She scraped together money for the bus fare and arrived at Engela, one of Namibia’s biggest state hospitals, a week ago. Ester was among the four cases of malnutrition admitted on the day she arrived, and it seems that her mother got her there in the nick of time.
The burden of malnutrition Nursing sister Josephine Hango explains that apart from the cases which come from the hospital catchment area, Engela District Hospital also has a regular influx of malnutrition cases filtering down from neighbouring Angola. The hospital treats all cases, regardless of the nationality of the child.
“Many of the people residing in the border areas of Namibia and Angola are seeking medical attention at the district hospital,” she says.
According to the recent Demographic and Health Survey 2013, 6 per cent of children under 5 in Namibia are wasted, and a quarter (24 per cent) are stunted. These high levels of malnutrition are at odds with the country’s level of wealth as a middle income nation. Namibia has almost twice the percentage of moderately stunted children than is expected of a country as economically developed as it is.
A slow road to recovery
Ester was too weak to stand on her skinny legs when she came to the hospital. She was only 7 kg – a child her age should weigh on average between 9 and 11 kg (World Health Organization child growth standards). The medical staff was worried and quickly attended to her condition. She was put on therapeutic feeding and given antibiotics to fight the infection she had also acquired.
The problem with severe acute malnutrition (SAM) is that it increases the severity of common infectious diseases. According to the World Health Organization, children with SAM are nine times more likely to die than children who are moderately malnourished. Their illness needs to be managed in in-patient facilities until complications are resolved.
“The baby was also put on F75 feedings. After three days, she was weighing 7.2 kg. And after another three days, she picked up a bit and was weighing 7.3 kg. It is also the responsibility of the health care workers to teach the mother how to give the feeding to their babies,” explains Sister Josephine as she looks down at the patient file.
Little Ester scrunches her big brown eyes and starts crying again as the nurse approaches her and her mother with a cup of F75 milk, formulated specifically to treat SAM. The necessary but painful diagnostic blood tests, the unfamiliar environment and strange faces around her all seem too much for the little girl. Her mother cradles her and then gently feeds her the therapeutic milk, which seems to calm Ester down. She eventually settles and the stress lines on her small forehead disappear.
The importance of proper infant feeding Sister Josephine explains that the underlying causes of malnutrition are HIV and AIDS, tuberculosis, low levels of exclusive breastfeeding and diarrhoea, caused mainly by using water from contaminated water sources. Ester’s mother admits that she only feeds her millet porridge as they are too poor to get any other food.
In the border areas of Namibia and Angola, families face similar challenges: poverty, food insecurity and inappropriate infant and young child feeding practices, especially the lack of exclusive breastfeeding. Breast milk meets 100 per cent of an infant’s needs for energy, protein, calcium, vitamin A, vitamin C, iron folate and zinc in the first six months of life. It is by far the best choice for infants, protecting their immunity and reducing health costs for both families and the health system.
Yet, less than half (49 per cent) of babies under 6 months of age are exclusively breastfed in Namibia, and it is common to give fruit juices, plain water or even solid food to babies within the first three months of life. These harmful feeding practices often lead to sickness, which is further compounded by improper hygiene when handling children’s faeces or food. Frequent childhood infections detrimentally affect a child’s nutritional status, leading to a vicious cycle of disease and malnutrition.
A multi-pronged response
As nutrition is not only an issue of health, it needs to be tackled on many fronts, from addressing food insecurity to improving sanitation and hygiene and promoting breastfeeding. As a result, UNICEF is working with partners to mount a coordinated multi-sectoral response to reduce chronic malnutrition in children under 5 to less than 20 per cent by 2018.
“Experience from other countries has shown that a convergent approach to nutrition, where we bring together different sectors such as health, child and maternal nutrition, water and sanitation around the child, works best,” says Dr. Myo-Zin Nyunt, UNICEF Chief of Health in Namibia.
“Nutrition needs to be at the top of the political agenda in Namibia. Too many children are not thriving as they should be.”
