Tackling severe acute malnutrition in Mbeya

Malnutrition in infancy and early childhood causes lasting damage

By Chiara Frisone
Angel’s upper arm circumference is measured
27 June 2016

The pediatric ward at the Mbeya Referral Hospital is at full capacity. Children are admitted with a parent – usually their mother – for the duration of their hospital stay. Baraka Msuba is the only man on the ward. His two-and-one-half-year-old daughter, Angel, was admitted 15 days earlier with anaemia and severe acute malnutrition.

“Her mother could no longer take care of her so I decided to bring her here because she had lost her appetite and was becoming very sick.”

– Baraka

Like other children on the ward, Angel suffers from severe acute malnutrition, meaning that her weight is too low for her height. Extensive research shows that malnutrition in infancy and early childhood causes lasting damage, including poor cognition and educational performance and can even lead to death. As they grow, these children are more likely to become overweight, and when they enter adulthood they are more likely to earn less than their non-malnourished peers.

Angel with her father
Angel with her father, Baraka, in the malnutrition ward at Mbeya Referral Hospital.

At her age, Angel should already be walking and talking, but instead she is tiny and cannot stand on her own two feet.

Severe actue malnutrition affects 100,000 children 0-59 months in Tanzania. However, Biram Ndiaye, UNICEF Tanzania’s Nutrition Manager, believes that “severe acute malnutrition does not receive the same attention as chronic malnutrition because of the low prevalence observed in Tanzania.” Many severely acute malnourished children who survive will never fully recover and their development and their cognitive abilities will be forever compromised.

Over the course of 15 days, Angel received special, high-energy and highly nutrient food and antibiotics. Her condition has improved dramatically and she is now ready to go home. Baraka is glad to see her child active and playful. “I didn’t think she would make it,” he says. “I didn’t know what malnutrition looked like, so I couldn’t do anything to help her. But now I’ve received information from the nurses, so now I know what Angel needs to eat to grow well.”

Lack of knowledge around the type of foods children need to eat for optimal growth is one of the main reasons leading to undernutrition. “Mothers do not know how to feed their children nutritious food,” Eddah Lamson Sinjella, one of the nurses at Mbeya Referral Hospital, says. “Many mothers also work and leave their children with their grandparents or the house girls who do not have the right knowledge about infant and child feeding.”

Nurse Eddah Lamson Sinjella performs one last check on Angel
Nurse Eddah Lamson Sinjella performs one last check on Angel before she is discharged from the malnutrition ward at Mbeya Referral Hospital.

Poverty also plays an important role because many families might not be able to afford vegetables and fruits other than those that are cheaper and readily available where they live – and this often means porridge, maize, spinach, beans and rice. However a varied, balanced and nutritious diet with food from all four food groups – dairy, grains, proteins, and fruit and vegetables – is necessary for a child to grow up strong and healthy.

Before going home, Baraka visits Sameyani Onesmo, one of the hospital’s nutritionists. Sameyani gives him advice on how to improve Angel’s nutrition and a box of ready to use therapeutic food to take home. “I see cases like Angel’s very often because a lot of parents feed their children only one of the four food groups or don’t feed them enough. We have a lot of different foods available in Mbeya but parents don’t know how to cook them,” Sameyani says. To address this, the Mbeya Referral Hospital runs monthly nutrition clubs during which a group of around 100 parents who are clients of the facility learn to prepare and cook different types of food. The hospital also runs ‘kitchen gardens’ where they show parents how to grow different types of vegetable and also teach them about hand washing and hygiene when handling food.

Angel is fed a therapeutic food
Angel is fed a therapeutic food during the nutrition counselling session with Sameyani Onesmo at Mbeya Referral Hospital.

Baraka is glad to see Angel smile and play with Sameyani. After packing the food and a couple of leaflets, he is now ready to go home. He will bring Angel back to the hospital for follow up in a week’s time. “I have received really important information here. I now know what to cook at home and how to prevent Angel from falling sick again. I hope Angel will grow up without malnutrition and that she will be able to go to school and find a job one day,” Baraka concludes.