How poor feeding is causing malnutrition

Deafening wails from children being treated for different illnesses at Nalufenya children’s hospital in Jinja District are heard from a far.

Toddler Nantale, from Katwe Village, Kangulumira Sub-county in Kayunga District, is among those seething in pain at her sickbed besides her mother, Ms Rehema Temujibwa.

She has been in the hospital battling malnutrition for a month.

“I was giving her food such as Irish potatoes. I couldn’t afford milk. One day, I found her with burn blisters which I thought were burns from fire. But when I brought her here, doctors said my child was malnourished,” Ms Temujibwa says.

Just next to Nantale is a teenage mother from Budondo Sub-county in Jinja District, with her two-year-old child.

“I am financially incapacitated and I couldn’t buy her milk which doctors told me to fed her on,’’ she says, adding that her husband is a peasant farmer.

The two toddlers are among the 40 children admitted monthly at the facility for suffering from malnutrition, according to statistics from the hospital authorities.

As the children here continue to suffer from malnutrition, Dr Esther Babirekere, a paediatrician at Mulago hospital’s Mwana Mugimu nutrition section, says such children may not grow tall, their brains will be incapable of performing tasks of their age and they stand higher chances of dying.

“Good nutrition for babies is important for them to grow tall and the development of their brains and other body organs. Poor nutrition will lead to babies being shorter than their age and since the brain is also affected, they will not perform the tasks of their age,” Dr Babirekere adds.

Mwana Mugimu nutrition section, Dr Babirekere says, receives for rehabilitation between 80 and 120 children every month.

“Some die, some survive,” Dr Babirekere says.

The number of malnourished children received at Mwana Mugimu nutrition section and Nalufenya children hospital, however, mirrors what is happening in the country.

According to the Finance, Planning and Economic Development minister, Mr Matia Kasaija, at least 53 per cent of children are malnourished.

“Despite the variety and quantity of foods that Uganda can produce, 53 per cent of children under five years are malnourished and hence anaemic, and 29 per cent of them are stunted or wasted,” Mr Kasaija says in the recently presented budget speech.

Sadly, he adds: “Many women of reproductive age are also malnourished, with 32 per cent of them being anaemic.”

Gifted by nature, Uganda has two rainy seasons in a year, which are March to May and September to December.

The soils and rainfall received through the seasons and temperatures, all favour the growth and survival of different flora and fauna. But malnutrition continues to adversely affect children.

Uganda, according to Mr Kasaija, is thus paying through the nose to treat effects of malnutrition, a condition that results from deficiency or oversupply of nutrients in the body.

“In addition, inappropriate feeding, especially among the more affluent, is also a major cause of a surge in chronic non-communicable diseases including coronary heart disease, cancer, diabetes, high blood pressure, and obesity. These maladies are largely attributable to unhealthy lifestyles,” he says.

“Consequently, Uganda has been spending on average $500m (about Shs1.8 trillion) on treatment of preventable diseases,” Mr Kasaija says.
Why malnutrition amid food abundance?
Ms Agnes Kirabo, the executive director of Food Rights Alliance, a coalition of civil social organisations working in the field of sustainable agriculture and food security, blames the government for the rising malnutrition.

She says the government has been preaching the gospel of commercialisation of agriculture with little regard to diversity and food security at household level.

As a result, Ms Kirabo says some regions have taken up sugarcane, tea, and matooke as the only crops grown which has exposed them to food insecurity and thus malnutrition.

“We have been, for some decades now, in some kind of agriculture transformational agenda that is now hitting the wall. Many of our diverse foods we were planting and eating are disappearing. And now that there are multiple competitions for land, and yet many of these nutritious foods have been wild crops, the worst is to come. People are using chemicals which have killed termites and other insects which are vital for the biodiversity,” Ms Kirabo says.

She adds: “To get out of this scenario, we need our politicians to show commitment, first to end hunger and then malnutrition. They should use the same energy to promote growing of diverse foods as they have promoted commercialisation of food.”

A dream yet to be achieved
Ending hunger in some regions, especially in the semi-arid Karamoja Sub-region, however, remains a dream.

According to the Famine Early Warning Systems Network, some regions, especially Karamoja, northern Uganda and Teso sub-regions, are already food stressed with households there having exhausted their food stocks in March, yet “below-average first season (March-June) rainfall has led to an absence of seasonal vegetables”.

“Poor households exhausted their food stocks in March, and below-average first season (March-June) rainfall, which has led to an absence of seasonal vegetables and a significant decline in agricultural labour demand, reducing household income and food access more significantly than previously anticipated. Food prices are expected to rise, and could remain high even after the harvest,” reads part of the report.

The minister listed three key issues that need to be done to address the challenge at hand. These include coming up with coordinated actions, mass sensitisation and education, and lifestyle awareness.

Dr Babirekere says some parents are not doing enough to address malnutrition. She said some mothers do not want to breastfeed yet it is well known that breast milk is the best food for a baby.

Exclusive breast feeding
“My appeal is that for babies under six months, mothers should exclusively breastfeed. After six months, when the baby needs more food, they can now complement with other foods but breastfeeding should continue for at least two years,” she says.

A child who is malnourished beyond two years of age, Dr Babirekere says, maybe permanently damaged.
Malnutrition is being addressed by different government ministries including Education, Health, Agriculture and Gender.

Mr Aggrey Kibenge, the undersecretary in the Ministry of Education, says learners are being taught how to address malnutrition right from an early age.

“There is content in the school curriculum that enables learners know the causes of malnutrition and how it can be avoided. Some schools with access to land have gone further to engage in practical lessons,” Mr Kibenge says.

Dr Joyce Moriku, the Minister of State for Primary Healthcare, says stunting is the worst form of malnutrition that the country is facing.

She cites Tooro Sub-region, where one in every four children are stunted, to highlight the magnitude of the problem.

“Tooro is not among the poorest regions in the country but it has the highest number of stunted children. The problem is the mindset of people. They produce food but they sell it,” Dr Moriku says.

According to the 2016 Uganda Demographic and Health Survey, malnutrition tends to be highest among the children born to illiterate parents.

“About four in 10 children born to mothers with no education (37 per cent) are stunted compared with one in 10 (10 per cent) of children born to mothers with more than a secondary education. Similarly, stunting decreases with increasing wealth quintiles, from 32 per cent among children in the lowest wealth quintile to 17 per cent of children in the highest wealth quintile,” reads part of the 2016 Uganda Demographic and Health Survey.

“The data show that 29 per cent of children under 5 are considered to be short for their age or stunted and 9 per cent are severely stunted stunting is slightly higher among male children (31 per cent) than among female children (27 per cent). Stunting is greater among children in rural areas (30 per cent) than urban areas (24 per cent),” reads part of the survey.
Stunting, according to the survey is highest in Tooro at 41 per cent and lowest at 14 per cent in Teso Sub-region.

Ms Sarah Opendi, the State Minister of Health in charge of General Duties says: “We are providing necessary information in all our health facilities about nutrition. We are also offering treatment and we have directed NMS to put food supplements as one of the key essential commodities in all health facilities,” Ms Opendi says.

She says the said 53 per cent malnutrition figure is higher and instead put it at 38 per cent.
Ms Opendi says some regions have been experiencing hunger and such consequences are expected.
Minister Kasaija’s proposals
Among the interventions, Mr Kasaija says industrial food will now be fortified with vital nutrients for major staples and cooking oils consumed in public institutions such as schools, hospitals and the country’s security forces, all schools will be required to establish and maintain vegetable gardens for educational as while as a source of vital nutrients in school diets, and government will revitalise nutritional education conducted by Village Health Teams.

What global body says
According to the World Health Organisation, “malnutrition is estimated to contribute to more than one third of all child deaths, although it is rarely listed as the direct cause”.
“Lack of access to highly nutritious foods, especially in the present context of rising food prices, is a common cause of malnutrition. Poor feeding practices, such as inadequate breastfeeding, offering the wrong foods, and not ensuring that the child gets enough nutritious food, contribute to malnutrition,” adds WHO.
Scientists say everyone should have a diet comprising of vegetables, fruits, animal products such as milk and meat, fish products, water but all the foods should be in moderate levels.