Esther smiles again after her one year old baby is cured of severe acute malnutrition

Improving nutritional status of refugee children

By Irene Nabisere
A woman and three children
Irene Nabisere
01 January 2016

Yumbe, 2016 - Esther Amony (20 years) and her family are part of over 150,000 South Sudanese refugees living in Bidibidi Refugee Settlement in Yumbe District, West Nile.  Dressed in a coffee brown skirt with patterns of white, orange and brown and a black blouse, Amony is at her new home, preparing a meal for her family as she waits for the husband who enrolled in primary school with their two children to return. Esther has 3 children, her first born is 5 years and was delivered at 15 years.  The second born is 4 years.  Even after getting displaced by the war in South Sudan, she is happy her family is alive and healthy while in Uganda.    

As the situation deteriorated in South Sudan in July, Esther and her family had to seek refuge and their destination was Uganda. Her last born, Lakot James aged one and half years suffered from severe acute malnutrition. “We walked for over eight hours from Serotenya to Madi Opei border in Lamwo District. We lacked food for several days and did not have enough breast milk for Lakot,” narrates Amony. 

At the screening point in Nyumanzi transit centre in Adjumani District, Lakot was found to have marasmus upon her arrival on 10 August, 2016 and was referred to a health post.  He was given Vitamin A to boost his immunity and deworming to prevent worm infestation. 

Due to congestion at the centre, Amony and the family were relocated to Bidibidi settlement in Yumbe district a day after their arrival.  As soon as they reached Bidibidi reception centre, Lakot’s condition worsened. He was admitted to the UNICEF and Concern Worldwide Inpatient Therapeutic Feeding Centre (ITC) where he stayed for 8 days. 

Lakot weighed 6.6kgs on admission. With a mid-upper arm circumference (MUAC) of 10.9cm, Lakot suffered from severe diarrhoea, vomiting and fever. He was given therapeutic milk, amoxicillin, rehydrated with RESOMAL (Rehydration salt for the malnourished) and weighed daily. After two days, Lakot’s situation was worsening. He lost appetite and stopped feeding. The clinicians and nutritionists introduced nasogastric tube (NGT) for nutritional feeding support plus stronger antibiotics to ensure continued feeding; and to stop any other underlying infections.  On the fifth day, Lakot started to recover.  On the eighth day, Lakot was weighing 7.3kgs with a MUAC of 11.2 and was discharged to Out-Patient Therapeutic feeding centre (OTC) where he was given plumpy nut, antibiotics and the mother received counselling on infant and young child feeding.

I fed Lakot as was told by the nutritionist. I took my recommended food rations and was able to breast feed Lakot again in addition to the plumpy nut and antibiotics.

Esther Amony

Within two months, Lakot was discharged from OTC through supplementary feeding program for monitoring.  He was weighing 8.7kgs with a MUAC of 13.0cm.     

Charlotte Nakate, a nutritionist with Concern Worldwide a UNICEF partner says they were amazed at how fast Lakot responded to treatment. “It usually takes a child three months to recover but Lakot’s mother did everything as recommended hence the quick responsiveness to treatment,” Nakate says. At ITC, Mothers who had witnessed Lakot on admission were astonished by the quick recovery and requested for the NGT even those that did not need it. Mothers were sensitised on the ITC programmes.

Amony has a back yard garden where she planted beans, maize and potatoes in order to supplement food rations provided by other partners as well as ensure nutritious food intake for her family.  She is able to harvest the dark green leafy vegetables for a nutritious diet.

Wilson Kirabira, UNICEF Nutrition Officer, Gulu Zonal Office says that the UNICEF curative and preventive nutrition programmes help to have healthy children. The curative programme ensures children in ITC and OTC respond quickly due to quality treatment, monitoring and follow up of cases to household level by UNICEF and its partners Concern Worldwide and District Health staff.  Preventive programme includes maternal, infant and young child feeding, micronutrient supplementation through vitamin A to boost immunity and deworming to avoid worm infestation and counselling mothers on proper feeding habits. Majority of the children enrolled are cured.

As of September 2016, over 100,000 children had received Vitamin A supplementation since January 2016. Since the July 2016 influx, 45,493 children have been screened for malnutrition, 584 were found with SAM and 567 were referred for appropriate treatment. According to the Food and Nutrition Assessment done by UNICEF, UNHCR and WFP with other partners in 2015 amongst South Sudan refugee hosting districts of Adjumani, Arua, Kiryandongo, and Koboko, the GAM and SAM rate is 7.2 per cent and 0.8 per cent respectively.

UNICEF supports refugee children in humanitarian action with WASH, Education, Health and Child Protection services as stipulated by the
UNICEF core commitments for children in humanitarian action global framework that promotes predictable, effective and timely collective humanitarian action to fulfill the rights of children affected by humanitarian crisis.