Hitting the moving target of malnutrition in Karamoja
"COVID movement restrictions stopped many mothers from visiting the health centres where they get the feeding supplements"
While a baby with a birth weight of 5 kilograms is not a rare occurrence in Uganda’s capital, Kampala, a two-year-old weighing 5 kilograms in Karamoja sub-region is not rare either. In fact, what is shocking to even seasoned health workers in Karamoja is that such an acutely malnourished child could survive that long before dying. But intensive care, initially lasting three months, has managed to save some of the children. And very many more who have benefitted from timely UNICEF-supported interventions before their situation reached such frightening levels have recovered and grown to lead normal lives.
John Okurut the Nakapiripirit District Nutrition Focal Person has a few hundred cases of children in different stages of recovery from acute malnutrition. UNICEF provides support for therapeutic foods including Ready to Use Food (RUTF), formula Milk 75 and 100 and Rehydration Solution for Malnutrition (ReSoMal).
The one for severely malnourished children is a ready-to-use therapeutic foods (RUTF) paste, which is according to the Ministry of Health’s List of Essential Supplies and Medicines, is virtually medicine and can only be provided under prescription. The second is a supplement combination. Ten of the 13 health centres in the district provide this therapeutic food to save the lives of wasted children.
At Nakapiripirit Health Centre 3, we meet enrolled Nurse Sagal Elvio Gostol who is in charge of nutrition activities. He explains that a very important aspect of his work is to advise mothers on the locally available foods that they should feed their growing babies as they gradually wean them off the therapeutic foods first and ultimately from breastmilk.
At any given time, Sagal has 10 to 15 infants on RUTF which, if diligently given, lasts no more than three months, upon which they ‘graduate’ to a community supplementary feeding programme. After this, if they meet the discharge criteria, they are left to the full care of the mothers from home.
Unfortunately, only about half of the children are diligently given the complete dosage of RUTF, which the mothers get once a week, to last seven days of intensive feeding. In many cases, the supplement is also given to the other children in the home.
On the morning of our visit, Sagal has just secured permission from the health centre management to encourage the mother of a severely malnourished two-year-old boy who weighs 6 kilograms to bring him in daily instead of the weekly visits, in the hope that they will be able to give him a full dose of therapeutic food at the health centre. The management staff are even skeptical and not sure that the mother will adhere to routine of bringing the baby daily to get the full dose under their watch. Such behaviour of some deviant mothers doesn’t stop Sagal from continuously talking to them to encourage them to seek medical attention for their malnourished children.
At Nakapiripirit Health Centre, we meet baby Benjamin Ogule who, at two years, weighs 6.9 kilograms. But this is after being on RUTF for two months, and though his weight has barely increased above what it was on enrollment, he is definitely healthier, and can now stand up, something he couldn’t do earlier. He is malnourished though at two years he is not too short, standing at 76.5 centimetres on his thin legs. His mother, Nawala Maria, was only feeding him maize porridge and pledges to start giving him silver fish and beans when he recovers.
At Namalu Health Centre III, enrolled Nurse Alice Apuun explains that women in the area are the ‘family breadbasket’, so their inability to adhere to the treatment/feeding regime is not surprising.
“She has to be in the garden, look after up to nine other children, and so spending a day walking to and from the health centre is difficult to fulfil consistently,” says Nurse Alice.
Unfortunately, when COVID-19 struck, says Alice, movement restriction stopped many of the women from visiting the health centres where they get the feeding supplements.
But the mothers’ pursuit of therapeutic feeds has had its advantages besides the obvious one of saving their malnourished children. Apuun explains that the health workers use the occasions to give mothers as much education as possible, explaining the relationship between the health of their children and the type of food they give them.
In addition, other health seeking behaviours are encouraged in the process. Immunization, in particular, has been registering more adherence because of these nutrition visits. Other preventive health activities are also promoted during the nutrition programmes. Key of these is sanitation. Alice and the team keep drumming the sanitation messages, and also high on the agenda in the nutrition sessions is family planning and child spacing.
Not far from Nakapiripirit town, we find the home of 18-year-old Eunice Langole Petwa. Her eight-month-old son, Aaron Jovan, weighs only 7 kilograms and this is after two months on RUTF. He was weighing 5 kgs when he started the treatment. The reason for Aaron’s poor health is not hard to see; his mother Eunice is already five months pregnant.
Clearly, the problem of malnutrition in Karamoja, while an emergency that must be responded to as it happens, also needs to be tackled more seriously by enlisting the cultural and national political leadership as champions and advocates in the fight against malnutrition in the communities.