Monday, March 24, 2014

Making Nyakibale Baby Friendly

In addition to coordinating malnutrition management throughout Rukungiri District, IECM has been working to make Nyakibale Hospital Baby Friendly.  Our FANTA Nutrition Fellow has been working with midwives from both ANC and Maternity to draft a Baby Friendly Health Initiative Policy here at the hospital to ensure that babies get the best possible start to life. 

To aid in the project the Program Coordinators have been knitting hats to distribute to newborns after delivery.  As newborns can easily become hypothermic the goal is to help keep these infants warm and comfortable in their first hours of life while mothers begin breastfeeding. This is particularly important for infants born prematurely due to their smaller size and decreased development.

The hats are not only helping to protect babies from the cold, but are giving mothers a keepsake that can later be passed on to younger siblings. Currently the Program Coordinators have knit 8 hats that are being distributed at the Maternity ward. More to come over the next few months!

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Thursday, February 27, 2014

Inpatient Treatment at Kebisoni Health Center IV

With the help of IECM and three NACS trained staff, Kebisoni Health Center IV has received its first inpatients this week including one referral from Nyakibale Hospital. Before December, Nyakibale used to be the only facility in the District providing care for malnourished patients. Now select Health Center IVs and IIIs are able to provide care free of charge throughout the District.

Irene an eight-month-old severely malnourished, HIV exposed patient arrived at Nyakibale with her mother on Monday. Without money to pay for treatment at Nyakibale the mother did not know her options for treatment. However, now Kebison, Rukungiri, Bugangari, and Buhunga Health Center IVs are trained to treat inpatients free of charge in Rukungiri District. Staff at the Outpatient Department at Nyakibale along with IECM staff determined that Irene lived closest to Kebisoni Health Center IV. All of Irene’s anthropometric measurements were taken and recorded on a referral slip.

That evening her mother brought Irene to Kebisoni. On Tuesday IECM followed up with Kebisoni staff. In addition Irene had taken the allotted two sachets of RUTF. Her cough had subsided and anti-retroviral treatment was planned. Now, Irene is taking six daily rations of F75 high-energy-milk and has gone from 3 kg to 4.2 kg in four days. Thanks to the hard work of government staff trained in NACS in December, coverage of malnutrition treatment services is accessible, affordable, and effective in Rukungiri District.

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Friday, February 7, 2014

Building Local Capacity for Malnutrition Treatment

Initiative to End Child Malnutrition (IECM) is expanding its inpatient and outpatient services greatly in Rukungiri District by training government health workers at select health centers. With the New Year has come a new approach to providing malnutrition services to the children who need it most in the District. Outside the gates of Nyakibale Hospital, the center of IECM operations, we have been building capacity and carrying out extensive support supervision of the health centers whose staffs were trained in NACS in December 2013. NACS stands for Nutrition Assessment Counseling and Support and is recognized by the Ministry of Health as the standard for treatment and prevention of malnutrition.
Despite providing intensive NACS training for 25 health workers, training alone is not enough to implement NACS at the health centers. Since training, each health center has received essential supplies, assistance in holding on-site trainings, and on the job mentorship. For example, in order to screen patients for malnutrition and determine who qualifies for nutritional support, each received a stadiometer, a scale and MUAC tapes. All children, pregnant or lactating women and any HIV+ clients must be screened for malnutrition. For adults, using the Middle Upper Arm Circumference (MUAC) as an indication of malnutrition is enough but for children under 5 we also check their Weight-for-Height. The stadiometer is used to measure height and this figure is compared to the child’s weight in order to make a diagnosis. In addition to screening tools, the health centers also received reporting tools and were directly involved in compiling weekly and monthly reports. Staffs have also showed initiative by improvising and creating their own forms where NACS does not provide a specific tool. For example, health centers have created their own registers to track screening which is used to calculate the catch-rate at each site. The catch-rate can help assess nutrition needs surrounding each site.

Since only 2-3 health workers per center received NACS training, another important step has been to ensure that they share their knowledge with other health center staff. In order to stop the cycle of malnutrition, nutrition needs to be integrated into all aspects of health care and not just viewed as a problem for young children. For example, nutrition must be addressed on the maternity ward since a malnourished mother will give birth to a low birth weight baby. At least one on-site training has been held at each site to disseminate knowledge. These sessions are also an opportunity for staffs to delegate responsibilities, schedule follow-ups and set-up a system which can work at their center. IECM encourages local ownership of the program by using problem-solving skills to help staff improve their services and find solutions that can work at their specific site.

In addition to large group training, IECM also works one-on-one with staff to answer questions about the treatment protocol and reporting tools. IECM has extensive experience in running outpatient therapeutic care sites and providing high quality care for inpatients that need special attention. It is crucial that we transfer these skills and this knowledge to staff outside of the hospital so that more children can benefit from nutrition support services. Practical training has been the most important since many of these staffs have not treated malnutrition in the past. Questions are often best answered in the context of treating a specific patient. One site has already admitted two inpatients and it has been crucial to visit and help them calculate how much formula the child should receive and how to accurately prepare it.

IECM is making a difference in Rukungiri District by sharing its expertise with health workers. Through these health workers we are reaching further than ever and enabling staff to provide essential nutrition support to more children than before.  

Learn more about Ujenzi Trust at

Thursday, January 30, 2014

The Story of Shanita: Treating Malnutrition in Children Less Than Six Months

At Bugangari Health Center IV in rural, Southwestern Uganda, the Initiative to End Childhood Malnutrition (IECM) has run an outpatient therapeutic care (OTC) site since 2011. Bugangari is one of seven outreach sites IECM managed in 2013. The catchment population of Bugangari is similar to that of the entire Southwest region. According to the Ugandan Demographic Health Survey in 2011, the region has the second highest rates of severe and acute malnutrition in the country, second only to the Karamoja region, which is prone to drought and conflict.

In August, a two-month old severely malnourished infant named Shanita came in with her grandmother to the IECM outreach site in Bugangari. At 2.3 kg she was enrolled as an outpatient and started receiving infant formula since her mother had passed away. Over the next few weeks the IECM outreach nurses noticed that Shanita’s condition was not improving. The nurses took the time to explain to the grandmother, Shanita’s caretaker, the necessity of bringing the infant into Nyakibale hospital for inpatient therapeutic care (ITC). ITC is administered on a special malnutrition ward separated from other pediatric patients to avoid transmission of disease since malnourished patients have a depressed immune system. Without proper attention and close monitoring by clinical staff, Shanita’s condition would not improve. While convincing a caretaker to leave her village, family, and farms is difficult, Shanita’s grandmother agreed to travel 18 km to Nyakibale Hospital for inpatient care. She was transported back by IECM’s outreach team in their Rav4 for the forty-minute care ride back to Nyakibale hospital.

Within hours of being admitted to the malnutrition ward, the nurses and our Food and Nutrition Technical Assistance (FANTA) Nutrition Fellow discovered that Shanita’s grandmother was not able to properly prepare formula. In fact, why would she? All of her children and all of her grandchildren had been breastfeed. She was excessively diluting the formula that the IECM outreach team had been providing her on a weekly basis at Bugangari. After observing and teaching her how to prepare the milk, she was able to make it on her own. Over the next twenty days Shanita went from 2.4 kilograms to 3.18 kilograms and was discharged back to our outreach program at Bugangari. Until Shanita was able to start taking solid foods at six months, IECM was able to provide infant formula for her grandmother to prepare.

Without IECM, there would not have been out outpatient site where Shanita’s grandmother could access treatment close to home. Just as importantly, the program provided all outpatient and inpatient treatment free of charge. Without the program Shanita would never have received infant formula. And, with her mother deceased, she would have passed away silently in Bugangari.

IECM has transitioned to following Uganda’s national guidelines for the treatment of malnutrition, namely Integrated Management of Acute Malnutrition (IMAM). For those infants under six months who are not effectively breastfeeding, the guidelines encourage counseling for mothers. However, for those infants who do not have access to breast milk, the guidelines encourage the use of diluted F100 (high energy milk only available through inpatient therapeutic care), or infant formula. However, caretakers must purchase the infant formula, which is not provided free of charge like the F100, F75, and Ready-to-use-therapeutic-food (RUTF). Infant formula can cost approximately 32,000 Ugandan shillings per tin (approximately $13), and many of our caretakers report earnings of between 5,000 and 10,000 shillings per month (about $4). Without IECM, Shanita would never have survived. It is thanks to the generous funding that has made treatment and prevention of malnutrition possible in Bugangari and all of Rukungiri District.

Learn more about Ujenzi Trust at