Life-saving education to prevent malnutrition
Vumilia Mwinuka, a 42-year-old farmer, sits at home for her weekly nutrition session with Anaspelina Boniface Kilowoko, a community health worker (CHW) in the village of Muwimbi in Iringa.
Anaspelina guides her through the best ways for safe and healthy preparation of food, and talks about the importance of preparing a diversified diet, washing hands with soap or ashes, and keeping everything clean.
Five-year-old Mateo watches while his mother sits along with others and demonstrates her routine in preparing a balanced meal of fish and vegetables. He is the youngest of Vumilia’s five children, the eldest being 18 and with a child of her own.
Smiling bashfully, Mateo says he can count up to 50. Mateo is learning the alphabet and looks forward to going to school. Two years earlier, his chances of making it to age five were very slim.
In 2016, Anaspelina had noticed the boy had signs of malnutrition. She referred Vumilia to a nearby dispensary for treatment, but his condition did not improve. The nurse there referred Mateo to the Ipamba hospital, which was located over 600 km away, for severe acute malnutrition. It was the worst case the nurse had seen in a decade.
Severe acute malnutrition, or very low weight for one’s height, is the most extreme and visible form of undernutrition, and severely impacts child survival and long-term well-being. In Tanzania, 34 per cent or 3.3 million children under-5 years suffer from chronic malnutrition (stunting or low height-for-age) and 58 per cent or 5.6 million suffer from anaemia as per data from the TDHS-MIS 2015-2016.
Mateo’s stomach was bloated, and he suffered from diarrhoea. In Tanzania, 312 children under-5 die of preventable diseases like malaria, diarrhoea, and pneumonia every day according to the Levels and Trends in Child Mortality Report 2018, while diarrhoea accounts for 8 per cent of these cases. Mateo’s diarrhoea was associated with acute malnutrition. Vumilia recalls her son as being “lifeless” when they had arrived at the hospital. “We didn’t think he would make it,” she adds.
It took three months before Mateo began to recover. Anaspelina encouraged his parents to join the local counselling group sessions to learn about optimal feeding and childcare practices and overall family health, and continued visiting the household to follow up.
Now Mateo is growing well and is enrolled in pre-primary school in the next-door hamlet of Ulete. Anaspelina comes by once a week for support. “She’s like a mother to me,” Vumilia says of the woman whose vigilance saved her son.
The Government of Tanzania launched the Integrated Management of Acute Malnutrition (IMAM) scale up plan, and UNICEF with NGO partners are working to deliver it “all the way from the ministry door down to the last of the village houses”, as Dr. Edoardo Occa of Doctors with Africa CUAMM puts it.
To help scale up this life-saving service, UNICEF through NGO partners like CUAMM focuses on increasing the proportion of health facilities providing treatment of children with severe acute malnutrition (SAM), so that children like Mateo don’t fall between the cracks.
However, the challenge remaining is increasing the demand for this important service. UNICEF and partners have put extra efforts to increase demand for IMAM, by supporting SAM screening by community health workers. “The overall challenge to us remains the mobilization of adequate predictable funding for effective scaling up of IMAM services,” says UNICEF Nutrition Chief Mauro Brero.
Two years after suffering severe acute malnutrition, Mateo is recovered and strong and looking forward to school.
Acute malnutrition normally caused by sudden reductions in food intake or diet quality is preventable. The region has ample rainfall. Crops are plentiful, but not diverse enough to provide the adequate nutrition and balanced diet children need to thrive.
Maize is the main nutritional staple in the region. Farmers relied on it for steady yield, and mothers for cooking Makande (maize mixed with beans), the staple corn-and-bean meal that is often the only meal.
Dr. Occa explains that this is not classic food insecurity but nutrition insecurity. Their work tackles the issue on both ends, starting with teaching farmers to diversify their crops and grow a greater variety. At the same time, UNICEF supports to teach parents about the nutrition children require to thrive throughout the various stages of infancy and early childhood to ensure proper development. Research shows that rates of stunting, wasting, and underweight in children generally decrease as maternal education increases according to USAID data.
Nutritional informational sessions take place in monthly counselling groups, held by village CHWs like Anaspelina, who are trained in recognizing signs of malnutrition. They also understand their communities, and the practical and traditional obstacles that sometimes keep people from seeking conventional treatment or adhering to it.
Sometimes when parents take the children for treatment and see an initial improvement, “they see the child isn’t cursed, and abscond on the treatment”, says Hadija Halidi, programme manager at UNICEF’s partner CUAMM.
The distance between rural communities and the hospital in Ipamba underscores the need to increase services at the local level. Halidi explains that malnourishment treatment for young children is free, but travel and extended absence often deter mothers who must pay for their own stay and food while leaving other children at home.
According to Anaspelina, what nearly killed Mateo was “not enough information about how to prepare the food. Just poor nutrition. He was lacking protein.”
After attending the counselling sessions, Vumilia learnt about the importance of a diversified diet for her children, who have different needs at different ages, including her eldest, who is a mother now. Vumilia now grows her own garden for a handy supply of fresh vegetables. She washes them first, avoids overcooking to preserve vitamins, and serves protein. “I wish I had this information before,” she says.
With this programme, more parents now have this life-saving education to prevent malnutrition and raise healthy children.