SAVE LIVES OF 600 MALNOURISHED CHILDREN IN UGANDA

1. Introduction

The saving lives of 600 malnourished children project are one of the forefront projects at CFU as malnutrition is still a challenge in Uganda, especially in the underserved urban communities and deep rural areas. Child and Family Foundation Uganda (CFU) is still working on Tooth and Nail to deliver different nutrition interventions to the people with an aim of reducing cases of Malnutrition and their occurrences.

Health worker Training, community dialogues, and community outreaches are being conducted to involve the health facilities, community leaders, and government health focal persons in the saving of children from malnutrition. From the training, the health workers who were trained are working hand in hand with CFU to screen for malnutrition among children and their households. 3 stakeholder training was conducted in the last quarter to build capacity and teach them how to screen and manage malnutrition cases in their areas. A total of  48 health workers from 21 health centers, together with more than 50 Community Health Workers were trained in the two-day training.

In the last quarter, we were able to carry out 24 community outreaches which were integrated with services like nutrition education, Food demonstrations, Vitamin A supplementation, and deworming.  We also screened for malnutrition, 32 (16M & 16F) cases of malnutrition were found after the screening.  Among these, 6 had Severe Acute Malnutrition (SAM)   whereas 26 had Moderate Acute Malnutrition (MAM). All these cases were managed until got well and were discharged to the community to be followed up by the community health workers.

SUCCESS STORY

Baby Kato, a 9-month-old male twin was found by the community health workers during the door-to-door home visits activities. After assessments, he was referred to our Medical Center. At the medical center, His mother reported that with a low appetite, his son was not growing so well compared to the twin brother and other children of the same age. She reported that the child is so small and appears unwell.

On examination, baby Kato was looking sick and weak.

1. Respiratory rate of 45b/min
2. Weight: 6.4kg
3. Length: 64.5cm
4. Mid-upper arm circumference (MUAC): 11.6cm (Y)

Upon assessment, he was found with Moderate Acute Malnutrition (MAM)

Interventions

1. Blood smear for Malaria was positive.
2. He was put on antimalarials to treat malaria.
3.  Nutrition counseling message was given on the subsequent visits with the following topics:

• The factors to consider when complementary feeding.
• Giving extra meals to the twins, especially the sick one.
• Preparation of a triple mix locally known as kitoobero.
• Preparation of a balanced diet with locally available cheap foods
• Maintaining proper sanitation at home to prevent diarrhea and other related diseases.
• Enriching home meals such as porridges.

For the follow-up visits as scheduled by the Medical Officer, baby Kato healed from malaria and gradually started improving, gaining weight as follows (6.4Kg, 6.5, 6.8, 6.9, 7.2, and 7.4kg respectively ) and the MUAC also increased (11.6 cm, 11.7, 11.9, 12.2, 12.3 and 12.5cm respectively). Baby Kato was then discharged from the Outpatient Therapeutic Centre (OTC), to be followed up by the Community wealth workers.     

 Achievements

• Children who were found malnourished were treated until they got well.
• More health workers were trained in the assessment and management of malnutrition.

 Challenges

• Staff turnover in many of the health facilities, which makes some trained health workers leave the project area hence affecting the project.

 Lessons Learnt.

• Training and conducting Continuous Medical Education (CME) always remind health workers of their role in fighting malnutrition.
• Involving community leaders in any project leads to its success since they mobilize people to attend and get the services offered to them.
•  Home visits ensure client follow-up in the community and reduce lost follow-up.

Conclusion

• The project is running so well and communities in the project area are gaining from it, all thanks to the GlobalGiving community for the continued support to the children of Kampala and Uganda at large. 

1. Introduction

In the third quarter, we were able to carry out 24 integrated community outreaches and 9 home visits in which we screened for cases of malnutrition, immunized, gave out Vitamin A supplements and deworming tablets to children.  

We received 20 cases of malnutrition of which 7 had Severe Acute Malnutrition (SAM)   while 13 had Moderate Acute Malnutrition (MAM). All these cases were managed at our facility until got well and were discharged.

Cases of malnutrition are still high in Uganda especially among the underserved Urban communities and rural areas. This is due to the high prices of food stuffs and prevailing economic constraints among the parents especially in the urban areas, whereas in rural areas illiteracy and poverty are the primary causes of malnutrition. The children in these households consequently miss out on eating nutritious foods which would have enabled their bodies to be healthy. During the CFU community outreaches and home visits, the community team penetrates the city slums and the rural areas to  take services closer to these children so that they also have smiles on their faces.     

As stated in the last quarter, the other cause of malnutrition as discovered by CFU was existence of Cerebral Palsy (CP) among some children in the communities. These children are so prone to malnutrition due to the feeding difficulties which are secondary to CP. The team is also giving special attention to these children to enable them to improve their lives.

FOOD DEMONSTRATION

4 Food demonstrations were conducted in the community and the mothers who had been trained during the previous food demonstrations were leading during the sessions while being supervised by CFU team to assess if they had learnt from what had been taught to them. They were able to group food stuffs according to their food values and to prepare different meals in nutrient-conserving preparation methods. This is of great importance since it builds the confidence of the mothers and makes them practice more of what they teach other.

SUCCESS STORY

Baby Rachel a 16month old girl was brought by her teenage mother, in one of the community outreaches. Rachel was still breastfeeding with complimentary feeds. The mother’s main concerns were that her child was not growing as expected, she could not stand, she was so weak and small for her age. The community team screened her for CP and Malnutrition and referred her to Child and Family Foundation Uganda (CFU) medical center.

Rachel was brought to CFU medical Center on 5^th August 2022 and the mother narrated her concerns to the doctor including low appetite for food and 7 episodes of diarrhea in 5 days .

On Examination, Rachel was sick looking, not anemic, no dehydration and a clear chest with:

1. Respiratory rate of 48b/min
2. Weight: 7.1kg
3. Length: 71.0cm
4. Mid upper arm circumference (MUAC): 11.8cm (Y)

Upon assessment, she was found with Moderate Acute Malnutrition (MAM) and diarrhea

Interventions

1. Blood smear for Malaria which was negative.
2. Oral Rehydration Solution was prescribed to prevent dehydration.
3.  Nutrition counselling message which included:

• The advantages of eating a balanced diet with animal proteins and calcium.
• Procedure of Preparing of a triple mix (Kitoobero)
• Advantages of proper sanitation at home
• Preparation of high energy porridges .

During follow up days as scheduled, the diarrhea subsidized, and Rachel started gaining weight. (7.1Kg, 7.3, 7.7, 8.2, 8.5, and 8.8kg respectively ) and the MUAC also increased (11.8 cm, 11.9, 12.2, 12.5, 12.7, 12.8 and 13.0cm respectively) and now she is very fine and walking.  

1. Lessons Learnt.

• Involving mothers in activities such as food demonstrations builds confidence among the mothers in communities, and they also turn out to be champions in eradication of malnutrition.
•  Home visits ensures follow up of all activities  in the community and reduces lost follow up.

Conclusion

• The project is running smoothly as planned and many children are having better health standards and are now living happily.  

• OCTOBER_Quarterly_report_for_Global_giving_Reporting__1.pdf (PDF)
  

2.1 Activity Description

2.1.1 Outreaches

A total of 24 outreaches were done In Kanyanya, Kawempe I and Kawempe II parishes (Kiganda, Ttula, kirokole, kiyanja, ssebagala and Lutunda zones).

In Kawempe, 398 children were screened for malnutrition of which 16 cases of malnutrition were managed in the months of April, May, and June 2022. These children were found during the various malnutrition screening activities conducted within the quarter and at the different health centers within the Kawempe North constituency. The primary cause of malnutrition is poverty, especially among the town dwellers who at times are referred to as the “Urban poor”

Most of the “Urban poor” survive on only one meal a day if they get a chance to have it. The meal consumed by the family may be deficient in the required food values especially proteins since they mainly afford carbohydrates from root tubers such as Cassava. This leads to excessive hunger in the homes and later Malnutrition kicks in. The members of these households do not know about nutrition and the foods they need to eat to eradicate malnutrition in their families.

During the various community visit sessions, we discovered that malnutrition is high among children with disabilities such as Cerebral Palsy. Some of these children have difficulty swallowing or chewing, reducing the amount of nutrients they take. They also have a problem with the digestion of the food they are given which leads to malnutrition after some period.

At Child and Family Foundation Branch in the Kamuli district, a total of 78 children were screened for malnutrition which included those attending OPD and Static Immunization clinic. Among them, 3 were found malnourished. They were enrolled in the nutrition clinic for management.

FOOD DEMONSTRATION

A food demonstration was conducted, and the members were taught how to prepare enriched porridges. Cereal porridges are commonly prepared which provide carbohydrates and ensure satiety of an individual but are deficient in Proteins. The addition of high-value proteins makes the Cereal porridges more nutritious for the individuals hence reducing the chances of malnutrition occurrences at affordable costs. This also brings about sustainability since the foods used to enrich the cereal porridges are affordable in the communities.

These porridges were enriched as follows:

• Millet porridge with milk
• Millet porridge with eggs.
• Millet porridge with simsim and peanut butter.
• Millet porridge with silverfish.

Personal hygiene was emphasized as a basic point to prevent other illnesses such as diarrhea which in turn affect the nutrition status of the individuals. The mothers were taught that proper sanitation in their communities and personal hygiene are very instrumental in the eradication of water-borne diseases which according to the World Health Organization are immediate causes of Malnutrition.

The mothers were also tasked to arrange the foods according to the food values they provide to the body. The foods included eggs, milk, millet, mangoes, nakati, red amaranthus, yellow bananas, silverfish, simsim and peanut butter, and sugar.

After the training, the mothers were able to group the foods according to their food values 

SUCCESS STORY

Nakamaanya Nimura, a 7month old baby girl from Lutunda zone, in Kawempe division was referred to Child and Family Foundation Uganda (CFU) by the Community Health Team members attached to Child and Family medical center on 27^th April 2022.

The mother narrated that her daughter had recurrent diarrhea and she was not looking healthy compared to the children of her age. When the community health worker assessed the baby, He told her it was because of “Poor feeding”. She was then referred to CFU for nutrition management.

Nimura was presenting with 5 episodes of watery diarrhea in the week as reported by the mother, with no fever and a slight cough. She was still breastfeeding with complementary feeds.

On Examination, Nimura had a fair general condition, well perfused, no dehydration, and a clear chest with:

1. Respiratory rate of 52b/min
2. Weight: 5.6kg
3. Length: 64.5cm
4. Mid upper arm circumference (MUAC): 11.2cm (R)

She was diagnosed with Acute watery diarrhea of Severe Acute Malnutrition (S.A.M).   as shown below.

Medical Findings after Examination

INTERVENTIONS

1. An oral Rehydration Solution was prescribed after every motion to prevent dehydration.
2. Septrin tablets for the cough.
3. Maternal HIV status was investigated in the laboratory and fortunately, it was non-reactive (HIV negative), which ruled out chances of the baby being HIV-exposed.
4. The mother received a session of Health Education which included:

• The importance of eating a balanced diet to Nimura and the entire family.
• Proper sanitation was emphasized to prevent other occurrences of diarrhea.
• Preparation of Enriched porridges
• Preparation of a triple mix (Kitoobero)
• A food demonstration during one of the subsequent review visits.

On the scheduled review days, Nimura started to improve greatly, with a significant weight gain (5.6kg, 5.8, 6.2,6.5, 6.7, and 6.8kg respectively.) and the MUAC also increased (11.2cm, 11.3, 11.4, 11.5, 11.7 and 11.8cm respectively). The steady gain amused the mother because she was using affordable food items to treat her daughter.

• Quarterly_report_for_Global_giving_Reporting_.pdf (PDF)
  

SAVE LIVES OF 600 MALNOURISHED CHILDREN IN UGANDA (48930)

In the last quarter, we continued to seek out those with malnutrition from the different parishes in Kawempe. We realize that prevention is better than cure, so when we identify children on the verge or those that are cases, we educate them on providing a balanced diet in their context or using the available resources in the households. Those that need medical attention are referred to CFU medical center for further assessments and management. In this report, we would like to share a journey we have taken with one of the children.

Angel’s story would not have been possible without the extra hand given by you. We don’t take that for granted and Angel could only say it by going back on the growth chart track. Angel was 11-month-old when we identified her from Kiyanja Zone, Kawempe Division. She is the last born of 4 children. Her mother, Eunice operates a fresh food kiosk in Kiyanja zone.  The village health worker attached to CFU on one of her village assessments, during her door-to-door rounds within Kanyanya Parish, identified Angel with severe acute malnutrition on 30th August 2021. Kanyanya is an informal settlement with a fairly crowded population. Angel was linked to CFU for further management.

On further reassessment at CFU Medical center, Angel weighed 6.3 kg, height 68.7 cm and Mid Upper Arm Circumference was 11.4 cm. and categorized as severe malnutrition with a bad skin rash (severe seborrheic dermatitis) that had lasted for 2 months. She was enrolled in Outpatient Therapeutic Care (OTC) program at CFU immediately. The OTC clinic is where children with malnutrition are enrolled. She stayed on the program for about four weeks and was eventually terminated due to the plumpy nut stockout. Plumpy nut is a high-energy snack donated by UNICEF and every now and again it becomes unavailable. Angel was 6.9kg and with moderate malnutrition when she dropped off the program.  

Following stockout, Angel deteriorated in a week’s time into severe malnutrition. She had profuse developed diarrhea during this time and that could have precipitated her condition. She was then managed with oral rehydration salts and zinc.  

High energy feeds (locally known as the kitobero) were prepared for her in the absence of plumpy nut. Ekitobero is a mixture of all the four food groups and is served after mashing it. The mother was taught to prepare ekitobero using the foods available at her home by the CFU team. She was further educated on hygiene practices and together with the health worker came up with a feeding plan. Within two weeks, Angel registered improvement while on kitoobero exclusively. She gained weight successively to 7.2kg, 7.8kg, and then 8.5kg by month three. The skin rash and diarrhea had resolved.  

Quarterly report on the support of adolescents

Child and Family Foundation Uganda (CFU) team is excited to share our quarterly report of supporting the health needs of 1000 adolescents in rural Kamuli Uganda at https://goto.gg/50405with support from GlobalGiving donors and supporters. Your donations have enabled us to conduct a number of activities in the Kamuli district Busoga region, Eastern Uganda.

Integrated outreaches

Different services were offered to the community with the objective to offer free medical assessment, health education, and promotion of sexual gender-based violence and prevention of STIs.

 reference Figure 1. Dr. Ssunna assessed the community in an integrated outreach at Butaaga village

Child days plus activities

In partnership with local government authorities in the Kamuli district, we were able to implement child day plus activities at Nawansaso Parish. Up to 35 adolescents HPV vaccine to prevent them from acquiring cervical cancer

Reference: Figure 2. CFU Medical team reaching the community in the Child day plus outreaches at Nawansaso Parish

Adolescent Family Care Groups (AFCGs)

Two AFCGs comprising 15 adolescents each were formed in our communities. These AFCGs have been trained on adolescent health and wellbeing education including but not limited to;

• Taking iron and folic acid supplements improves adolescent iron status and reduces the risk of anemia
• Prevention of Sexually Transmitted Diseases and Infections (STDs and STIs)
• Taking care of physical health through regular exercise and getting adequate sleep
• Observation of personal hygiene e.g., bath regularly, keep your hair and nails short, trimming of pubic hair

See youth group in Figure 3. CFU teams in partnership with DREAMS teams mentoring AFCG in the Lutunda zone

  Impact of our activities

In Kiganda zone, Kawempe division slum settlements, we met an adolescent mother who was a victim of Sexual Gender-Based Violence (SGBV) with a severely malnourished child of six months who could not even sit. Her spouse left the family with a rent bill of 6 months to clear and no job to earn a living. After interventions and with support from GlobalGiving CFU was able to offer nutrition services, rented a house for the mother, and helped her to start up a small-scale business. On follow-up, the baby’s nutrition status had improved after using RUTF and the mother was also linked to a counselor at the facility who was able to give her counseling on SGBV.

See Figure 4. SGBV mother before intervention in Kiganda Zone and Figure 5. SGBV mother after interventions

We thank everyone for donating to this project since its inception.