Malnutrition still a challenge for children in Karamoja

Annually, about 1,014 children under five out of a target population of 22,740 are expected to be referred to the Nutrition ward at Moroto Referral Hospital with severe malnutrition, according to hospital statistics for the financial year 2022-2023.

Robert Mukasa
Baby Arichu Angiro, carried by her mother, Topoth Regina, on receiving assessment at Moroto Regional Referral Hospital on 28.07.2023.
UNICEF/Tibaweswa
08 August 2023

In Karamoja, a tragic portrait of human suffering unfolds. The world has classified it as one of its most destitute corners, where an overwhelming 61 percent of the 1.2 million people are condemned to live in absolute poverty, according to the Uganda Demographic and Health Survey of 2016.

Annually, about 1,014 children under five out of a target population of 22,740 are expected to be referred to the Nutrition ward at Moroto Referral Hospital with severe malnutrition, according to hospital statistics for the financial year 2022-2023.

The haunting reality of Karamoja's despair can scarcely be put into words; it's a sorrow that must be seen to be believed. Yet, one place where the grim statistic takes on a horrifying life of its own is the Nutrition ward, or Inpatient Therapeutic ward, at Moroto Referral Hospital.

In the eight-bed ward, you are met with a sight that wrenches the heart. Children under five years old, shadows of their former selves, lie lethargically on beds or rest in their mothers’ laps. Their bodies are thin and wasted; their eyes are dull, tormented by relentless hunger. Swollen bellies, protruding bones, and peeling skin stand as silent testimony to a health that is deteriorating.  

In the hospital compound and in the corners of the ward, the mothers sit, overwhelmed by despair. They fail to recognize these acute malnutrition symptoms, attributing them to mere fate or a bout of Malaria or Tuberculosis.

Outside the hospital, Karamoja continues to wither. Hunger and stunting are not mere words here; they are the very fabric of life. Food is not a pleasure but a dream out of reach for many.

Mothers struggle to make ends meet, barely affording a meal even once a day. At the nutrition ward, mothers are informed that malnutrition weakens their children's immune systems, making them susceptible to diseases like tuberculosis. Most of the babies at the ward had bouts of Malaria, Tuberculosis, and Oedema-the buildup of fluid in the body that causes the affected tissue to become swollen, all triggered by malnutrition.

In a joint interview with volunteer nutritionists at the nutrition ward; Peter Lokoru and Richard Odongo, startling statistics were shared about child malnutrition in a region with a catchment population of 1,245,600. Annually, the hospital, which is one of several in the region where children suffering from malnutrition are treated expects referrals for admission of about 1,0141 (4.6%) children under five, with an average of 30 admissions per month from the nine districts that constitute Karamoja.

 

“The peak of admissions usually occurs during mass screenings in the villages, which help identify malnutrition cases that may otherwise go unnoticed.”

Lokoru, volunteer nutritionist at the Moroto hospital nutrition ward.

Lokoru said the screenings have become vital because many mothers are unable to recognize that their children are malnourished until symptoms like body swelling, skin peeling, and wasting away appear. This misrecognition often leads to late referrals, making treatment more difficult. In July 2023 alone, four children died at the hospital because they were referred too late to the hospital.

Lokoru said treating a child with severe malnutrition is very difficult. "Managing one very sick child suffering from malnutrition is equivalent to managing two children in the general ward," he said.

These children are usually treated using ready-to-use therapeutic food (RUTF), a peanut-based paste which is rich in protein and contains specifically packaged medicine for treating malnutrition in children.

 "It contains all the ingredients that the patient needs to recover," reads an RUTF dosage chart pinned in the hospital ward.

The situation is further complicated by parents or care givers who escape from hospital with their sick children to look for food, causing their sick children to miss medication and return in a worsened state. Food insecurity makes it challenging for families to afford a balanced diet rich in proteins, carbohydrates, vitamins, and greens, the nutritionists said.

Baby Chegem Paulinah eating ready-to-use therapeutic food (RUTF) at Moroto Regional Referral Hospital. To respond to the nutrition crisis, UNICEF with funding from ECHO and other donors is supporting a number of activities in the Karamoja region including the provision of ready-to-use therapeutic food (RUTF), and milk which are key in the management of severe acute malnutrition.
UNICEF/Tibaweswa
Baby Chegem Paulinah eating ready-to-use therapeutic food (RUTF) at Moroto Regional Referral Hospital. To respond to the nutrition crisis, UNICEF with funding from ECHO and other donors is supporting a number of activities in the Karamoja region including the provision of ready-to-use therapeutic food (RUTF), and milk which are key in the management of severe acute malnutrition.

UNICEF's interventions have been critical in addressing these issues. With funding from the European Union Commission for Protection and Humanitarian Aid Operations (ECHO) and other donors, UNICEF supports the Government of Uganda to treat children suffering from malnutrition through mass screening and detection, referral, integrated outreach programmes, supplying RUTF, therapeutic milk and medicines and water, sanitation, and hygiene programmes.

In addition, UNICEF implemented a three-month, cash-transfer support project to families with children suffering from severe malnutrition through mobile money. Although project has ended, it played a significant role in managing malnutrition, Dr. Idole Boaz, a nutritionist at the hospital, said in an interview.

To ensure timely response to the treatment of malnutrition, UNICEF has also handed out transportation vouchers to facilitate the timely delivery of patients and admissions. These actions have not only saved lives but have also supported mothers who often must walk kilometres for medical help, said Dr. Boaz.

Whereas 86 percent of the Ugandan population access healthcare within a five-kilometre radius, in Karamoja, only 17 percent of the population is within the recommended five-kilometre distance. Communities walk between 20 and 30 kilometres to access referral services, according to the Uganda Demographic and Health Survey of 2016.

The hospital has also struggled with relapses, according to Dr. Boaz. Children who initially recovered, are falling back into malnutrition, and returning within three weeks. The facility must deal with three to 10 admissions daily, managing both moderate and severe cases of malnutrition.

Dr. Boaz emphasised that UNICEF's transport vouchers have positively impacted both the communities and the hospital. Timely admissions have been critical in saving the lives of children.

Despite these efforts, challenges persist. Many children arrive in critical condition, making it difficult to save them. The provision of necessities such as hygiene, food, and care remains a struggle, emphasizing the continuous need for support from donors.

In 2022 alone, UNICEF with funding from donors supported the Government of Uganda to provide therapeutic nutritional support to over 77,000 children suffering from severe acute malnutrition in Uganda.
 

A portrait of Amongin Claudia (mother) and her baby, Ichumara Rachele at Moroto Regional Referral Hospital on 28.07.2023. The baby, who was suffering acute malnutrition is today recovering as hope has been reinstalled by the mother.
UNICEF/Tibaweswa
A portrait of Amongin Claudia (mother) and her baby, Ichumara Rachele at Moroto Regional Referral Hospital. The baby, who was suffering acute malnutrition is today recovering as hope has been reinstalled by the mother.