2-week Follow-Up

Herbert (not his real name) has been on the ward for two weeks now. Not only is he smiling again, but so is his mother Anna (not her real name). Anna happily reports that Herbert's edema is gone and that he is gaining weight, he's doing alright now. His treatment is not yet complete but Herbert has greatly improved in just two short weeks on the ward. Checking his bedside chart I can see the progress he's made, his weight decreased sharply as the edema resolved. Now his weight is rising since he's moved from Phase I to Phase II of the treatment protocol. In Phase II he receives twice the amount of high energy milk, which means twice the calories - this phase is meant for rapid weight gain and it's working for Herbert. His weight dropped to 8.4kg but is now 9.2kg, nearly a 10% weight gain since the edema has gone.

Edema at admission.

2 weeks later: The dent test
is negative, edema has
completely resolved.

Before coming to Nyakibale Anna said that she fed Herbert cassava, yams, and dodo (a variety of spinach) - a diet lacking in protein. From the health education sessions she has learned about a balanced diet and says that she'll add beans, mukene (small silver fish) and avocado to her son's diet - changes that should help prevent relapse of malnutrition.

Anna says "Thank you because you are helping me by treating my child" and also ensures that she will go home and tell others about what she's learned at Nyakibale and the treatment that saved her son.




Learn more about Ujenzi Trust at www.ujenzi.org

Child receives care thanks to neighbors' referrals

IECM is well known and trusted within the communities it serves. The story of one child who was admitted this week as an inpatient is a testimony to IECM’s reputation in Rukungiri.

Herbert (not his real name) is two and a half years old and clings to his mother’s body, his grip loosens and his swollen and fretful face brightens as his mother shares a chapatti with him, part of the free breakfast she received since being enrolled in the Meals for Mothers program. Herbert’s mother arrived the previous day to Nyakibale after Herbert was diagnosed with marasmus kwashiorkor at one of IECM’s outreach locations. Marasmus kwashiorkor is a severe form of malnutrition caused by a lack of protein and calories in the child’s diet and presents visibly as swelling in the legs, stomach and face with wasting (loss of fat) as well. The swelling, or edema, is diagnosed using the dent test; a health worker presses her finger on the child’s foot for three seconds. If a dent remains after releasing, the child has edema.

Pictorial representation of the dent
 test used to check for edema.

Nurse performs the dent test on
Herbert. He is positive for edema;
compare to photo on the left.

Herbert’s mother, Anna (not her real name) attended IECM’s outreach based on the advice of three other mothers, all of who had children who were previously treated at Nyakibale. These mothers recognized the same symptoms in Herbert as they had seen in their own children and recommended that Anna take her child to IECM’s nearest outreach site.

Anna says that she was not worried about coming to the hospital based on the testimonies of these fellow mothers. She wants to stay at the hospital until Herbert is healthy. She understands that the swelling in her child is due to poor feeding but does not yet understand what constitutes a balanced diet.

Thanks to their previous experience with IECM – receiving medical care and nutrition education on the pediatric ward, Anna’s neighbors recognized Herbert’s swollen legs and face as symptoms of malnutrition and referred him to an IECM outreach site. Based on their accounts, she was not fearful of leaving home to bring her child to the hospital. Herbert is now receiving the care he needs and is on his way to recovery.

Learn more about Ujenzi Trust at www.ujenzi.org

Growing healthy at Modern Primary

Modern Primary's addition to their
school garden.

Another successful community garden started by IECM is found at Modern Primary School located in Rukungiri Town. As another rainy season begins, it is time for planting. This week, we received seeds from NAADS to be used at Nyakibale and at Modern Primary.

The deputy headmaster oversees the garden and a gardener is hired for the heavy clearing, however teachers and students alike do the work of planting, weeding, weeding and harvesting. They have plans to add a fence to the plot and create a path from the school so that it can be more easily reached for teaching, demonstration, and of course gardening.

Today, 19 students ranging from ages seven to thirteen and two teachers skipped their morning tea break in order to visit the garden. The garden is much larger than the plot at IECM with piles of dead branches acting as dividers between the plots to distinguish between the different vegetables being grown.

Students help to plant eggplant.

These same primary students were present last summer when Harvard undergraduate volunteers visited classes to teach about balanced diet and the three food groups. The students were shy but able to answer my questions about healthy diets – however they were much more interested in climbing into the garden and getting their hands dirty planting vegetables. 

Learn more about Ujenzi Trust at www.ujenzi.org

Village Health Team Update

One of IECM's nurses explains the results of the
malnutrition screening to caregivers.

On Monday, the IECM outreach staff returned to Kikarara after having trained 26 VHT members the week before. The VHT members were asked to visit the homes within each of their "cells" (this can range from 15-30 households depending on the distance) and screen for malnutrition while also educating families about proper feeding.

VHT coordinators receive certificates
for attending the malnutrition training session.

The two VHT coordinators from Kikarara joined our staff and received certificates to distribute to the rest
of their team. Ten new patients were referred by the VHT members for screening by IECM. The referrals
were assessed for malnutrition by IECM Outreach nurses. None necessitated therapeutic treatment, but
the mothers received nutrition education for malnutrition prevention.

Caregivers, VHT members and staff pose together for a
photo in Kikarara.

Learn more about Ujenzi Trust at www.ujenzi.org

Engaging the Village Health Team

One of IECM’s main objectives in Rukungiri is to address the child malnutrition knowledge and skills gap of local health providers.  One of the project activities designed to reach this objective is a training program for community-based volunteers. The first level of health care in Uganda is a Health Center I (HCI). This community-based structure was initiated in 2001 as part of Uganda’a Health Sector Strategic Plan. There is no physical building; rather this health center is built of volunteers who have been chosen by their community to promote health and well being of the village. Volunteers within a village are assigned specific households and together form the Village Health Team (VHT).

IECM nurses lead the malnutrition screening and 

nutritional education training session in Kikarara Parish.

 26 VHT members and one SCORE field officer were in attendance.

The malnutrition-training program for VHT members began in January 2012 and from its genesis has been a collaboration between IECM, Nyakibale Hospital, the District Health Office of Rukungiri and the Ministry of Health. As of this week, we have trained a total of 120 VHT members in four parishes of Bwambara Sub County, our main target area.

A MUAC (Middle Upper Arm Circumference) is a simple tool used to diagnose malnutrition for ages 6 months and above. The MUAC is similar to a tape measure with a slit on one side to accurately measure the circumference

of the subject’s arm. Diagnosis is based on age.

In January 2013, we received approval from the District Health Officer to train all VHTs within our catchment area. Kikarara parish was chosen as the next training site because of the severity of cases that come for treatment, low patient numbers in recent months and our strong collaboration with SCORE (Sustainable COmprehensive REsponse for vulnerable children and their families) a project that works with communities the same catchment area. Our goal is to provide VHT members with the skills and tools needed to identify and refer cases of malnutrition to IECM’s outreach sites as well as malnutrition knowledge to counsel families on proper feeding and prevention practices.

IECM’s outreach team chose March 4th for the training and a SCORE field officer mobilized VHT members while IECM prepared the necessary supplies, including MUACs and malnutrition education handouts for each VHT member. 

IECM nurses demonstrate the proper use of a MUAC.

Training is interactive, nurses pose questions and VHT members discuss challenges they’ve faced in the field. Above, two VHT members volunteer to teach the rest of the group what they’ve learned. Fellow trainees are attentive to detail and supportive– during the peer education they point out errors and ask for clarification. The session was closed with a round of applause for everyone involved.

IECM will return to Kikarara on March 11 to follow-up with the VHT coordinators and handout certificates. As VHT members identify cases of malnutrition, they are advised to fill out a referral form and send the patient for further screening at IECM’s closest outreach location. VHT members are a valuable resource, bridging the gap between the formal health system and the households. IECM staff cannot reach individual households themselves but through this VHT training program, we are reaching farther than ever by strengthening the first line of care; the Village Health Team. 

 





Learn more about Ujenzi Trust at www.ujenzi.org