MALNUTRITION: Uganda: matooke is insufficient diet

13th March, 2011  By Agnes Kyotalengerire


A child recovering from severe kwashiorkor




WHEN Ritah Namara turned one year, her mother put her under the care of her 70-year-old grandmother. While at her grandmother’s, Namara ate matooke daily.
A few months down the road, Namara’s hair became silky and her stomach and face started to swell. She was also weak and dull.
Pauline Apolot, a nutritionist at Mwana Mugimu Nutritional Unit, Mulago Hospital, describes Namara’s condition as acute malnutrition. She says malnutrition results from eating an unbalanced diet — in which certain nutrients are either lacking, in excess or are in the wrong proportions.
Dr. Elizabeth Kiboneka, the head of Mwana Mugimu Nutrition Unit, says 42% of Ugandan children are stunted, an indicator of acute malnutrition. Stunting means a child has not acquired the right height for his age. This can begin as early as four months.
According to statistics from the Uganda Demographic Health Survey 2006, 6.1% of the children are acutely malnourished, an equivalent of 360,000 children. The statistics also reveal that 52% of the children with severe malnutrition are HIV-positive.
“People suffering from malnutrition have an extremely compromised immune system and are 10 times more likely to die of treatable illnesses like colds or diarrhoea, depending on which nutrients are inadequate or abundant in their diet,” she affirms.

Forms of acute malnutrition
Edematous malnutrition (kwashiorkor)
Masitula Nangobi, a nutritionist at Mwana Mugimu Nutrition Unit, says edematous malnutrition, popularly known as kwashiorkor, occurs when there is not enough protein in one’s diet.
She says edematous malnutrition presents with swelling of the face and feet, silky hair and peeling of the skin that appear like burns. Others are a pot belly, dry cracked eye cornea (in later stages), sores at the corners of the mouth, oral thrush and dehydrated tongue.
Besides, the child’s immunity slows down, making one prone to infection such as diarrhoea, TB and skin infections. In addition, the child becomes dull, unhappy and loses interest in their surrounding.
Nangobi says kwashiorkor is common in areas with famine and people with low level of education, leading to inadequate knowledge of proper diet.

Non-edematous malnutrition
This is a form of primary malnutrition commonly known as marasmus.
Kiboneka says marasmus results from a diet low in both protein and calories. It is characterised by energy deficiency, a child becoming skinny and weight reducing to less than 80% of the normal weight for one’s height.
In addition, though a child with marasmus may have dark hair, the child develops a creepy and baggy appearance, prominent cheek bones and no flesh on the buttocks and shoulder blades. The child also becomes irritable, cries a lot and is hyper alert.
Kiboneka says HIV/AIDS has been associated with marasmus because of loss of substantial amounts of the much needed fat and muscle tissue. Sometimes such children develop marasmic kwashiorkor.
She says marasmus increases before a child turns one year, whereas kwashiorkor occurrence increases after 18 months.

Predisposing factors
Apolot says severe acute malnutrition is a result of many factors with the immediate ones being inadequate dietary intake and insufficient access to food.
Apolot says though Uganda is referred to as a food basket, some households do not have food.
Inadequate maternal and child care practices can also spark off malnutrition, Nangobi says. She says proper nutrition starts before conception, continues during pregnancy and after birth.
She says the chances of a malnourished mother giving birth to a malnourished baby are very high. The same applies if the children are not breastfed enough and given enough supplements.
Nangobi adds that some young mothers lack the knowledge while others are inexperienced.
She says many Ugandans in rural areas lack safe drinking water or suitable sanitation. These conditions lead to infectious diseases that can cause diarrhoea, resulting in severe malnutrition.
Other factors include congenital abnormalities for example cleft palate, wher a child cannot eat properly. Cerebral palsy, congenital infections and muscular skeletal disorders are the other causes.
Apolot encourages exclusive breastfeeding. After six months, solid foods can be introduced alongside breast milk.
http://www.newvision.co.ug/D/9/34/749035