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.  

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