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Nutrition interventions give refugee children a second chance to life

By Proscovia Nakibuuka Mbonye

Martha Amour, a mother of four sits next to her small makeshift hut in Kiryandongo refugee settlement in Northern Uganda. She is feeding one of her one year old twin as the other children play in the backyard. “The twins love milk, she says with a smile. The twins have just recovered from acute malnutrition.

Kiryandongo refugee settlement is one of the urban refugee settlements in Uganda with over 38,000 refugees majority of which are South Sudanese who fled their country following a 2013 civil war. According to Robert Baryamwesiga, the Assistant Settlement Commander in Kiryandongo refugee settlement, 60 to 100 refugees are received per day and approximately 20% of the refugee children are malnourished. All children undergo a nutrition screening on arrival and those malnourished are referred to the nearest health facility for treatment.  

Amour recalls the harsh conditions, she and her children had to endure as they moved from village to village, town to town, in search for peace. Her children were greatly affected and their health deteriorated! ”We had very little to eat and drink, subsequently reducing the breast milk for my twins,” she narrates. No wonder, Amour's babies were declared severely malnourished on arrival. They were very weak, very thin and required immediate medical attention.

Around the same time, the Inpatient Therapeutic Care programme funded by European Commission’s Humanitarian Aid and Civil Protection Department (ECHO) and implemented by Concern Worldwide in partnership with UNICEF had just been initiated in Kiryandongo referral hospital. The first of its kind, in the hospital, the programme targeted nutrition in women and children to ensure mothers and their babies (both refugees and those from the host communities) were healthy.

The twins were immediately admitted under the programme and given the required treatment for several weeks. “The children loved plumpy nut, milk, porridge and in two weeks, they were back to life and bubbly,” Amour says.

The twins are among the 136 children that have so far benefited from the programme since its inception in March 2014. “The programme was very timely because the number of malnourished children including South Sudan refugee children was on the rise. All we had was a paediatric ward without a specific programme on nutrition” asserts Sr. Mary Adoch, the nursing Officer and Nutrition Focal person in charge of the programme. The therapeutic care programme that admits three to four children a day, has so far registered a 75% cure rate since it was set up.

Sr. Adoch remembers the twins when they just arrived and was happy to report that they recovered quickly. The programme has sufficient supplies like drugs, therapeutic milk, plumpy nut and very competent staff that provide services ranging from daily and routine nutrition screening and monitoring, nutrition and hygiene education for mothers, identification and treatment of infections, among others.

Baryamwesiga, says the UNICEF’s nutrition interventions were very timely given that majority of the refugees in this settlement are children and women, who are mostly affected by poor nutrition. “Prior to the UNICEF interventions, the Global Acute Malnutrition (GAM) rate in the settlement was alarmingly high - at 24%. There was a big need with limited capacity and resources. However, the situation has since improved bringing the GAM rate down to 8%,” he adds.

Dr. Fred Mutabazi, the Acting Medical Superintendent at Kiryandongo Hospital affirms that the UNICEF supported programme was very critical in boosting the screening, referral and treatment of malnutrition among children. “The programme is giving children hope,” he adds.

Amoru’s twins have since been discharged from the hospital after improving, but still benefiting from the programme through the Outpatient Therapeutic Care (OTC) services. The OTC services are provided by Village Health Team (VHTs) members who have also been trained under the UNICEF supported programme. Over 70 VHTs have been trained to screen, identify and refer malnutrition cases in a timely manner. 

Njiri Njwe, a trained VHT member continues to visit Amour to check on the twins’ health to avoid any relapses. During each visit, he screens the twins, measures their weight, height, temperature and provides some porridge for the children. He reemphasizes the need for proper hygiene while handling the children’s food during each visit. “Proper hygiene is very critical before and after feeding the children to prevent any other infections,” he stresses.

However, he notices that despite the progress, the twins are still behind on some of the major milestones. At the age of one, they still can’t stand or walk on their own. He encourages Amour to take the twins back to Kiryandongo Hospital for a thorough medical check-up. He states that if malnutrition is not tackled early, it can lead to death.

The VHTs also encourage refugees to start up kitchen gardens next to their homes where they can grow some food to supplement on the support that they receive.
Under the same programme, health workers have been trained and equipped with skills to identify and manage severe cases of poor nutrition. “Early identification of malnutrition cases leads to early treatment and follow-up, eventually reducing on the number of children dying due to the disease,” asserts Wilson Kirabira, UNICEF Nutrition Officer.




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