KARAMOJA– Eliza Namohe, 26 lines up to get food and treatment for her child at Namalu health centre III.
Namohe’s baby is two-and-a-half years old, but the child looks like a one-year-old and many people here believe the gods must have cursed the child.
Namohe is not alone; there are many women in Karamoja sub-region whose children look smaller than they are supposed to be.
At Namalu Health Centre where many women gather to get treatment and some foodstuff for their children, Dr John Anguzo, the District Health Officer Nakapiripirt says most of the children are malnourished because of poor feeding.
If you are a visitor in Karamoja homesteads, you would have to keep your emotions away; the sight of many malnourished children, many of them suffering from Kwashakor, in almost every homestead would necessitate this.
“Many of these children eat Cassava only and never drink milk, the parents can’t afford the essential food stuffs that can give a child a balanced diet, and they just feed the children anything even alcohol,” said Dr Anguzo.
“That explains why the children cannot even stand at the age of three years, the bellies are swollen, the hair is brown and they are sickly – all signs pointing to malnutrition,” added Dr Anguzo.
Dr Anguzo said the poor household food security situation has a cascading effect on infant and young child feeding practices, including the ability of mothers/care givers to provide meals of an adequate diversity and at an acceptable frequency.
Ms Christine Akello, a VHT in Nakapiripirit says she screens for malnutrition using the knowledge acquired from our training and that she can detect a malnourished child.
“I have Mid-Upper Arm Circumference (MUAC) tapes which I use for measurement and I have detected that most of the children in Karamoja here are chronically malnourished,” Ms Akello explains.
“I usually refer these children to health centres unfortunately, some children re-lapse either because their mothers are not handling them well or the mothers do not cook or they don’t know how to cook nutritious meals,” she explains.
Although the Uganda Bureau of Statistics (UBOS) key indicators report for the sixth Demographic and Health Survey 2016, indicates that the Infant Mortality Rate declined from 54 deaths per 1000 live births in 2011 to 43 deaths per 1000 live births in 2016, in Karamoja, Ms Akello says the deaths could be more due to malnutrition and other preventable diseases.
The Village Health System [VHT] system is one of the structures that the districts in Karamoja are utilising to engage the community and identify malnourished children and those suffering from other diseases.
According to a Food Security and Nutrition Assessment, July 2016 by WFP, UN Children’s fund and government of Uganda, the poor water, sanitation and hygiene situation with marked levels of utilization of unsafe water sources, limited treatment of water before use and the absence of sanitary facilities in majority of households also makes disease prevalence in the region.
The UN Children’s Fund (UNICEF) says mortality and malnutrition levels in Karamoja routinely surpass recognised crisis thresholds; the levels of education, literacy and access to information are extremely low, as is access to potable water and sanitation facilities all combine to create cyclic humanitarian crises of a disastrous scale and complexity.
Health workers in Karamoja reveal that new-born mortality remains a big challenge in Karamoja and that statistics continue to paint a grim picture with new-borns and children between the age of 1-5 continuing to die from preventable causes especially malnutrition.
A 2015 report on ‘Availability, utilisation and quality of maternal and neonatal health care services in Karamoja region’ by Calistus Wilunda and others emphasises the challenges to maternal and child health care in this area highlighting the break-down of the formal health care system, the increased frequency of epidemics, starvation, the problem of alcohol abuse, etc.
Mr John Nangiro, the LCV chairman for Nakapiripirit says the functional Health Infrastructure in Karamoja sub-region is either lacking at designated health facilities or has severely deteriorated due to inadequate budget allocations for capital development and maintenance activities.
He added that the deterioration of the health facility structures has partly led to the low productivity and performance of health workers due to low staff motivation.
Dr James Lemukol, the DHO Napak said Karamoja situation is a peculiar one characterized with very poor health indicators as compared to the rest of the country.
He explained that in Karamoja many children die due to preventable infectious diseases and that malnutrition is reportedly the underlying cause of many deaths.
“Can you imagine a child being fed on Cassava, Millet, Sorghum and alcohol residues throughout the day. Here, one in three deaths is caused by malnutrition and if this is not treated in time, the long-term impacts include stunted growth, blindness and impaired mental development. Malnutrition compromises one’s immunity and thus makes one vulnerable to infections and disease,” Dr Lemukol explained.
Dr Anguzo said malnutrition is a serious and often life-threatening condition caused by a diet lacking in essential proteins, fats, vitamins and minerals.
“The children suffering from malnutrition have an extremely compromised immune system and are 10 times more likely to die of treatable illnesses. These children show symptoms of malnutrition and they can be treated with the good diet for children,” he noted.
He urged the LCs and communities to take responsibility of taking children to hospitals, to get a report and ensure that they get adequate treatment.
“Mothers start supplementing breast milk with other foods between the ages of six months and two years. It is at this time that children are most at risk of developing malnutrition. It is unfortunate that mothers here introduce Sorghum, Millet, Cassava which only provides carbohydrates,” said Dr Anguzo.
Dr Anguzo noted that employing a multi-sectoral approach is the best way to curb malnutrition in Karamoja region and that some nutrition interventions are working because they employ a multi-sectoral approach.
He adds that working with structures that the community is familiar with like VHTs will enable the district penetrate the grassroots with behaviour change messages, all geared to reducing malnutrition.
He revealed that previously, nutrition used to be more of a health problem but that now it should be a concern for everyone and all sectors should work together to defeat it..
He said World Food Programme [WFP] has run to their rescue by providing its support through the district health centres, where the Government and NGOs provide antenatal and postnatal care, child immunization, growth monitoring services and health and nutrition education.
He added that the WFP’s assistance is intended to boost the nutrition and health of children aged 6-23 months and raise awareness of good nutrition and hygiene practices.
Dr. Peter Lokwang, the In-charge Takora Health Centre said inadequate nutrition during the child’s first 1000 days can lead to irreversible damage to minds and bodies, affecting a child’s ability to grow, learn and eventually rise out of poverty.
He added that the people affected by stunting, or reduced growth, are more likely in later life to be ill, to perform poorly at school or drop out of classes, to be less productive at work and even to die early.
Dr Lokwang, appreciated UNICEF’s regular support towards nutrition and other health concerns like maternal and child health.
“We have all the necessary medicines and supplies to treat malnutrition. We are so grateful to UNICEF. Our staff have been trained by UNICEF through CUAMM on how to address issues of malnutrition including severe acute malnutrition in the facility,” Dr Lokwang said.