A paediatrician writes from the field in Northern Uganda:
Recently, I spent seven days at Lira Regional Hospital working in the paediatric units. I was a participant in one of the medical camps organised by the rotary clubs of Uganda and India, and the Uganda Medical Association and Association of Surgeons of Uganda. The camps operated in Gulu, Kitgum, Pader, Amuru and Lira districts. What struck me most was the number of malnourished children attending the Lira hospital. The children ranged from the seven months to five years.
Some of the mothers said they had had family break-ups, hence no source of income to cater for the family, while others were involved in land disputes and could not grow food. Many mothers leave their children home and spend most of the day either tilling their fields or offering casual labour to generate money to buy food. Children receive one main meal in the evening and another miserable one in the morning, comprising mainly leftovers from supper. These meals are grossly inadequate.The medical superintendent of Lira, Dr. Jane Aceng, blames the situation on lack of food, HIV/AIDS related illnesses and diarrhoeal diseases. Families have returned home from IDP camps to find no land, no home, no safe water, no proper sanitation, no food, and no source of income.
Nutrition is the foundation on which human progress is built. Without food and nutrition children are especially vulnerable to contracting life-threatening diseases, which expose them to further malnutrition and a vicious cycle begins.
Worldwide, the death toll from hunger and malnutrition far exceeds that caused by even the most dramatic natural disasters. Studies have shown that girls that are born underweight are more likely to have stunted growth, and in turn give birth to underweight babies who are more receptive to disease. Children need a good nutritional start early in life to ensure healthy growth and development and to avoid long-term damage. Many malnourished children face greater risk of dropping out of school and living a life of poverty.
As a result of the war in northern Uganda, access to land was decreased, limiting the capacity of families to grow their own food. Most food eaten in the households is donated by the World Food Programme (WFP) and consists of maize flour, cooking oil and beans.
This food aid, which began in 1996, provided 78% of the daily food rations. Reports from the Ministry of Health and the Norwegian Council say 30% of the displaced population either did not receive food aid or received it irregularly.
Other additional food aid sources were provided through the school feeding programmes. To complement the food ratios received from WFP, the IDPs occasionally did some petty trading within the town or got temporary employment in casual labour activities such as alcohol brewing, charcoal burning, or digging for other people in exchange for food. Sanitation and living conditions were also poor in the camps.
Studies show that fever, lack of de-worming and absence of parents aggravate the malnutrition problem. Therefore, mothers should be supported and informed about the benefits of feeding their children adequately. Infections should be dealt with as early as possible, which requires sensitisation of the mothers on the danger signs to look out for in their children. Regular de-worming of children as well as improving their nutritional status is crucial.
Efforts should be made to ensure that the peace process reaches a logical conclusion. When political stability returns to northern Uganda, families will be able to settle and re-cultivate their land.
To meet the Millennium Development Goal target of halving hunger by 2015 (MDG1), education and agricultural extension should be undertaken, with emphasis on assisting women's groups. Agriculture and increased food production should be followed by the creation of business and work opportunities. Hunger and mlnutrition can thus be considerably reduced as incomes increase.
The traditional response to acute malnutrition has been to refer children to a hospital or specialised in-patient treatment unit, to be fed special milk-based diets. Though this treatment is effective, families in rural areas may not have easy access to health facilities that could provide such care. In-patient treatment is mandatory for this type of treatment. But this may not be an option for parents who cannot leave their homes for several weeks. In addition, severely malnourished children are vulnerable to infections as a result of weak immunity and could be at risk in crowded hospital wards.
World Health Organisation, WFP, the UNICEF and the UN Standing Committee on Nutrition say about 75% of children with acute malnutrition - those who have a good appetite and no medical complications - can be treated with highly fortified, ready-to-use therapeutic foods (RUTFs). These are palatable, soft and crushable nutrient- and energy-rich foods that that can be eaten by children over the age of six months without adding water, thereby reducing the risk of bacterial infection. A simple RUTF recipe can consist of full cream milk powder, sugar, groundnut paste, vegetable oil and combined mineral and vitamin mixture in calculated quantities. RUTFs provide the nutrients required to treat a severely malnourished child at home, without refrigeration and even where hygiene conditions are not perfect.
Studies in Mulago Hospital show that children admitted to the Mwanamugimu Nutrition Unit who received RUTF had a higher weight gain than those using the traditional high-energy milk. Considering this advantage, coupled with the definitely much higher weight gain observed and the convenience of administering the mixture in a home setting, RUTF can be a potentially better alternative to use in these children.
Interested donors could look at this as a better alternative to manage the plight of the malnourished children in the war-torn northern Uganda.
The problem of child growth and development is not only a medical one but it is also social and economic. The goal should be to create conditions in which women and children can thrive. This includes healthy mothers during pregnancy, better education, effective disease control and household food security.
By Angelina Kakooza Mwesige, Kampala. The writer is a paediatrician.
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