Malnutrition; a wild beast trying to cross their compounds

Early this month, I had a random visit to the therapeutic center in Kituti Health center in Kyangwali. This is one of the clinical initiatives in place to curb the malnutrition that has remained a problem in the refugee settlement and as well in the hosting communities. The clinical services have however not been my biggest focus while working in the settlement. Certainly, it is not just about the phobia that I at times develop while in a hospital facility but I guess it just has to do more with my interest and training in  preventive community centered approaches. To give you a snap shot of the malnutrition burden in Uganda, over 38 percent of children below 5 years of age are stunted while over 22 percent are underweight for their age (UNFS, 2003)! There is a possibility that at times such figures on paper paint a blurred picture until you meet a severely malnourished child. On that day at the health center, I happened to meet some child patients admitted for severe malnutrition. This boy looked so pale and was as thin as un-imaginable. The other had third degree oedema (swollen from foot to face) and rash all over the body. You would not want to imagine what these patients looked like a few days earlier based on the news from the health worker that they had tremendously improved by the time of my visit!

Surprisingly, the refugee settlement and surrounding communities are endowed with fertile soils and favourable rains throughout the year. More interesting is that Kyangwali is the food basket of the Bunyoro region and beyond. Driving through the refugee settlement, you will witness green fields of maize, beans and other crops! So there comes the great question, “where is the malnutrition problem coming from then?”  There have always been talks on pre-assumptions and various factors that have been attributed to this situation in the settlement. Many interventions are in place to put the condition in proper shape. Some of these include; seed distributions, case management through therapeutic and supplementary feeding program, growth monitoring, food preparation demos, and sensitizations. However, case management has become a main focus area among the interventions. In my view, the challenge still lays with the failure to justify these pre-assumed factors and major contributors to the poor nutrition among these communities. Doing this would help in identifying what interventions to prioritize where, how, and when. I often get worried that case management could become an ‘in and out cycle’ that may fail to realize case reductions in a longer run.  Malnutrition is like a wild beast on the loose that one has to kill before crossing in to his compound.

Well, upon this backdrop, we are already in the process of running an assessment in the communities to have a clearer picture on the common contributors to the problem with in the refugee settlement. We tried making this survey custom-tailored to the households that have faced malnutrition issues. I know you will not ask about how we identified the households since you can guess that we have records of clients in the supplementary and therapeutic feeding programs. Since I am not defending a research thesis, I will not over emphasize the criteria, but truth be told, we tried making the assessment very basic and user friendly for even a community health worker to administer. We are hence looking forward to our findings by the end of May and then we shall hopefully work more smoothly in assisting the communities conquer the wild beast.