Integrating nutrition into delivery of health services

A key component of UNICEF’s fight to eliminate new-born deaths in Karamoja

By Alex Taremwa
newborn health, maternal health, nutrition
UNICEF Uganda/2019/Adriko
28 November 2019

It’s a few minutes to 9am on Thursday morning and the Amudat Hospital shade already has over 30 mothers carrying their babies. The numbers keep growing with every passing minute.
Stella Cheplangant, a clinical officer at the hospital who also heads the Maternal Perinatal Death Surveillance and Response Capacity building (MPDSR) Committee mentions that the mothers have come to collect their rations of plumpynut – one of the ready to use therapeutic feeds for malnourished children. 

Given the poverty levels in the Karamoja sub-region, the World Health Organisation (WHO) discovered that at least one in every three children experienced stunted growth due to malnutrition. A recent UNICEF report also found that 84 per cent of people in Karamoja are unable to afford a nutritious diet – a major blow to efforts fighting neonatal deaths. 

As a result, UNICEF found it prudent to include nutrition among the Continuous Quality Improvement (CQI) interventions currently being implemented in 21 health facilities in Karamoja sub-region. In this programme, medical workers are trained in identifying babies born with nutrition deficiencies and mothers who have less than enough breast milk to give the baby for necessary nutrients.

“After the baby is born, we measure the baby to establish the weight. Normal babies often average between 3-5kgs. If the baby is lower than 2.5kgs, we put them on nutrition feeds from six months of age until they are two years. We have plumpynut, F-35 and F-100 for mothers with insufficient breast milk,”

Cheplangant explains.

Amudat Hospital’s weekly MPDSR assessments show an improvement in nutrition from 56.2 per cent in August 2019 to 97.9 per cent in September 2019. In other areas such as death audits, the use of the portograms, and postnatal reviews, the hospital already has a 100 per cent record. 

Dr. Patrick Sagaki, the medical superintendent at the hospital attributed the progress to the habitual MPDSR reviews that have put the facility in a position to identify high risk cases in nutrition service delivery using evidence-based audits. 

Sagaki adds that the use of CQI and MNH principles have empowered the hospital to be ahead of their challenges and as a result, Amudat Hospital has had no deaths of newborns from mothers who are monitored during labour in the facility.

“The fact is the MPDSR intervention has increased our capacity to identify early and deal with cases of severe malnutrition at the hospital. We can now also solve moderate malnutrition in the out-patient department. What is even more important is that the community believes in our capacity,”

Dr. Patrick Sagaki notes

In cases where mothers who deliver are found to have insufficient breast milk, Proscovia Takoba, a senior nursing officer and the regional QCI coach explains that complementary foods provided by UNICEF are added to the child’s diet. 

UNICEF is now working with the district administration to roll out the nutrition exercise at lower health centres for easy monitoring of complete referrals in a bid to post better return rates.