MALNUTRITION: Uganda: UNICEF and the European Union combat malnutrition in drought-stricken Uganda

Jeremy Green
KARAMOJA, Uganda, 27 June 2011 – A passing herd of cattle is a common sight in Karamoja, where the sound of their hooves gets lost in the gusts of wind that carry dust far beyond the village limit.
This daily scene is a reminder of deeper issues that challenge this remote region in north-eastern Uganda. Here, swaths of arid, unproductive land and a culture of nomadic cattle herding have led to severe food shortages and devastating hunger.
Karamoja suffers from one the worst rates of malnutrition in the world. In 2010, 16 per cent of children under the age of five suffered from acute malnutrition, and nearly 40 per cent of children in this age group were underweight.
To tackle this critical problem, the European Union humanitarian aid department (ECHO), UNICEF and Action Against Hunger are working hand-in-hand with Uganda’s Ministry of Health, referral hospitals, health centres, and communities to integrate the treatment and prevention of malnutrition into routine health services.

 © UNICEF VIDEO In north-eastern Uganda’s remote, drought-stricken region of Karamoja, nearly 40 per cent of children under the age of five are underweight.

This effort, known as the Integrated Management of Acute Malnutrition programme in Karamoja, or IMAM, is helping curb malnutrition in the region, and save children’s lives.

Fighting for survival
One-year old Lochoto Lochero and Francis Lokiru, 2, are both children whose lives have been saved due to IMAM interventions. Lochoto suffered from kwashiorkor, a common type of acute malnutrition caused by a lack of protein in a child’s diet. He developed skin rashes and oedema, and his body was swollen due to water retention.
Francis suffered from marasmus, a form of malnutrition caused by not having enough calories and protein for long periods of time. Francis’ little body was severely emaciated as a result of the condition.
When the two boys were admitted to hospital, their odds of survival were low. But after seven days of intensive medical and nutritional care, they both recovered and were able to return home.

 © UNICEF VIDEO :
The nurse at Moroto Health Centre in Karamoja, Uganda, gives Francis' mother plumpy nut, a high-protein peanut-based paste, that will help treat his acute malnutrition.

Weekly visits to the nearby health centre over the following weeks – part of the IMAM programme’s follow-up care – led to increased health and well-being for the boys. Just two weeks after returning home, Lochoto’s skin rash had almost disappeared and the swelling had gone down. Francis’ weight had increased to seven kilograms, and he was gaining energy and liveliness.
The IMAM programme reaches beneficiaries like Lochoto and Francis at home through the efforts of Village Health Teams, who track weekly progress and take anthropometric measurements.

Health teams on the go
In order to address the root causes of malnutrition, IMAM also includes training for the health teams to conduct health promotion activities with mothers on nutrition, food security, water and sanitation.
As more weeks pass, Francis’ appetite is getting better and his little body has gained more weight and energy. Lochoto’s skin is also looking healthier and his smile much bigger.

The VIDEO is well worth watching and is accessed through the website below:

UNICEF's Dheepa Pandian reports on efforts to reduce malnutrition in Uganda's remote Karamoja region. Watch in RealPlayer
http://www.unicef.org/infobycountry/uganda_59021.html

MALNUTRITION: Uganda: loses roughly $310 million worth of productivity annually

Lominda Afedraru : 19 April 2011

If most Ugandans were to adopt good feeding habits especially targeting children and mothers by giving them food that is rich in nutrients, the country would save $310million about (Shs737.8 billion) annually.

It is estimated that Uganda loses roughly $310 million worth of productivity annually due to accumulated effects of stunting caused in children through low birth weight, Iodine deficiency disorders as well as Iron deficiency.
It is further estimated that 4% of the country's Gross Domestic Product (GDP) is lost annually as a result of malnutrition.
These figures are revealed in a recently released report by Uganda National Academy of Science (UNAS) titled 'Mainstreaming Nutrition with Agriculture in Uganda; the role of Agriculture improving nutritional status of women and children.'
The report quotes Dr Elizabeth Madraa from the Ministry of Health as saying the extent to which malnutrition in the country affects productivity and the economy is a topic of concern and that the largest consequence of malnutrition affects labour.
The head of Nutrition and Home Economics at the Ministry of Agriculture, Animal Industry and Fisheries Mr Alex Bambona, is quoted as saying that the annual data indications of the country amount to a loss worth $38 million of productivity as a result of Iron deficiency; that causes anemia although other sources cite a slightly lower figure of $34 million.
"Having a nutritionally comprised workforce means that agriculture is negatively affected much more so than other sectors of the economy. Professor Judith Kimiywa, chairperson of the department of food nutrition and diabetes at Kenyatta University in Kenya notes that in Kenya there is an emphasis not only on productivity but also on increasing the incomes of the people," read part of the report.
The Ministry of Agriculture therefore described its recent development strategy by improving productivity in the first programme of their strategy as well as making sure that food is not only available to improve nutrition but also to improve incomes of those in need through already existing programmes of NAADS and "bonabagagawale" programme (prosperity for all).The deputy chairperson of UNAS Professor Opio Epelu during the launch of the report said for the economy of the country to run well, issues of nutrition must be addressed first in order to have an able bodied workforce that will be able to generate ample productivity in all sectors of the economy.
"Failure to prevent under nutrition early in life exerts a high social and economic cost that cannot be recouped because of the irreversibility of early deficits and the unavoidable negative effects later in life," he said.
He argues that a malnourished infant can have lifelong deficits in physical growth and development and physical activity.
Such sufferings and loss of human potential translates into social and economic costs.
While quantifying malnutrition in the country, it is stated that Uganda experiences high stunting rate of 38% in children under the age of five.
The prevalence of stunting in children between 24 to 35 months is estimated to be 48% and the prevalence of malnutrition and food insecurity varies from region to region with Northern and Southwest regions being rated as the highest.
Similar to other indicators of poor nutrition, the prevalence of chronic energy deficiency of less than 18.5 kg also varies across the regions among pregnant women between 15 to 49 years. The highest prevalence is recorded among women in Northern and Eastern Uganda.
Since agriculture is a major contributor to Uganda's prosperity and accounts for one quarter of the GDP, it is therefore the best sector to be used for improving the nutrition deficiency in the country.
Mr Peter Milton Rukundo, a lecturer at Kyambogo University said the problem of liberalizing the economy has brought about negative impacts on our economy because institutions like cooperatives where farmers used to access markets and credits facilities to operationalize their activities were killed.
He said there is no clear incentive in place for the farmers like it is in the western world and so the issue of overcoming nutrient deficits in the country may be a problem.
He said to push the idea of fighting food nutrient deficiency amongst the Ugandan community; Uganda needs a food nutrient Act that can be used by policy makers and the entire community to solving this problem.
"We need a legal framework to address this problem because in 2003, the Ministry of Agriculture came up with a nice policy on food and nutrition but this policy cannot be utilized unless there is a law in place to operationalise it. The policy addresses issues of sensitizing people to adapt to quality products including the food they eat. You know without this law we shall not catch up with global economic factors that affect us. For instance when the issue of liberalization and privatization was brought here, the World Bank came up with issues of debt reliefs which is not accessible to rural people...," Mr Rukondo said.
http://allafrica.com/stories/201104190039.html

MALNUTRITION: Uganda: Experts raise red flag on malnutrition levels

Stephen Wandera & Eve Mashoo : March 25 2011

Population experts have raised a red flag on the high rates of malnutrition, warning that unless immediate intervention measures are taken, Uganda is lying in a death trap.
It is estimated that about 2.3 million children are chronically malnourished and this affects their brains.
“Soon we are going to have these malnourished children with weak brains grow to become part of our labour force,” Dr John S. Ssebuliba, the National Planning Authority expert in-charge of population health and social development, said.
“This means we will be producing a less productive workforce because their slow-thinking capacity will make them less competitive in East Africa and the world at large.”

Dr Ssekamate said this at a dialogue on maternal and child nutrition on the theme, Together We Can End Preventable Deaths, at the Makerere University School of Food, Nutrition and Technology yesterday. The dialogue was organised by Actionaid, Plan Uganda and World Vision.
The NPA Chairman, Mr Kisamba Mugerwa, said this phenomenon is being addressed by developing a five-year Uganda Nutrition Action Plan (UNAP), which is aimed at addressing the neglected nutrition issues in this country.
“Government is aware of the fundamental role nutrition plays in the development of the human capital. We are quickly reformulating their policies to include nutrition as one of the top priorities in development agenda,” he said.
The plan estimated to cost Shs80 billion for the next planned five years proposes a multi-sectoral approach in several key ministries targeting children and reproductive women.
“We have finalised a five-year nutrition action plan focusing on women, children and people leaving with HIV among others. It will create a strong human capital that will propel this country to prosperity in the next five years,” Dr. Ssekamate said.
Ms Rudo Kwaramba, the World Vision boss, noted that much as the NPA has spearheaded so much activity, they still have the mandate to push for political will now that they are done with the planning process.
Uganda may fail to reap full benefits if there is no proper coordination and yet so much money gets in through numerous non-governmental organisations,” Ms Rudo added.

However Prof. Patrick Rubaihayo, an expert in plant breeding, dismissed the plan as unpractical to suit various local governments. Prof. Rubaihayo added that much as numerous stakeholders were proposing to put to task the President’s Office to work on the nutrition issues, he asked what the Vice President’s Office role was.
http://www.monitor.co.ug/News/National/-/688334/1132562/-/c3e2xez/-/

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