Uganda faces malnutrition crisis

By Stephen Kafeero

Deadly mix of poverty, hunger, superstition strikes the most vulnerable

Naigaga Hadija is 20. A few years ago, she left school in primary six to get married. She now has two children and a step-daughter. Kagoya Catherine is also 20. She has one child aged two and is eight months pregnant.

Naigaga and Kagoya are typical mothers in the dusty Bulagazi village in Magada sub-county in Namutumba district in eastern Uganda.

They are teenage mothers who got their first child when they are between 15 and 17 years old.

“My husband does not want me to use any family planning method,” says Kagoya, sadly. It is a claim you hear often from women here.

Their children typically look like walking bones with big tummies, scaly skin, and thin brown lifeless hair on sunken heads.

Naigaga’s step-daughter, Katono Zulaika, is three-years old but is the size of a six-month old baby. Unlike other children, she sits motionless all day in the compound. She does not laugh or play like other children and when you try to talk to her, she does not answer.

Although Naigaga’s other children look better than Katono, they all look sickly.

But Naigaga thinks there is no point in taking her children to the health centre for treatment. Like hundreds of others in the villages of Namutumba, she believes that the children cannot be cured in a hospital with western medicine because their ailment is a result of witchcraft.

Their parents believe the children are suffering from a disease they call olwenyanja (from the lake).

Unlike Naigaga, Kagoya has taken her daughter, Yoyeta Zubedah, to various clinics in the area. They all always give her the same diagnosis; malaria. But the girl never gets better. She is two-years old but is the size of a baby of a few months.

If these were isolated cases, they would still be too painful to imagine. But in Namutumba, there are hundreds of children and families suffering as a result of this belief.

Together, Naigaga, Kagoya and their children are just some of the problems that Gowan Tumye, the clinical officer in charge of the only medical facility in the sub-county, Magada Health Center, has to deal with everyday. He says the children are malnourished and the parents superstitious.

“The people survive only on cassava flour bread (chwada) and a change in the meal means they eat porridge made out of the same flour,” he says.

As a result, he says, up to 40 people died when the malnutrition situation intensified in May. He blames the people’s belief that they had been bewitched or suffering from Olwenyanja for most of the deaths.

He says most of the malnourished children arrive at his clinic with a lot of complications. Some have become very thin while others have swollen bodies that burst and discharge fluids.

When we visited him in August, over 40 children were hospitalised at the health centre because of severe acute malnutrition.

Naisaza Mey, one of the residents who volunteers at the health centre, says when some of the residents saw the children of those people who had been brought to the health centre getting better they began bringing more children.

“The situation was worse two months ago before the team from Mulago came here,” she says.

Makka Robert of Nsowola central village nearly lost his son to malnutrition.

“We delayed to bring him to hospital thinking what was disturbing our child was olwenyanja. We used to give him millet porridge only because that is what we could afford,” he says.

They took the child to the hospital in May, after the story of Namutumba’s hunger hit headlines and up to 15 children had died.

Tumye says he gives the children therapeutic food called F100 and F75 together with milk donated to the clinic by UNICEF.

He was also treating their other medical complications and said many more were being managed as out- patients.

It is not unusual for husbands here to stop their wives from taking the children to be immunised against child killer diseases like measles, polio and diphtheria. At Magada Health Center, children between the ages of 1 and 2 are sometimes immunised for the first time in their lives.

Tumye is distraught and wants help. “We do not have an X-ray and cannot do blood transfusion .This is why we lost 2 children as they were being rushed to Iganga Hospital,” he said.

He also wants to start an outreach nutritional program to advise people about which food to give to the children to prevent them from slipping back to malnutrition. He says Namutamba residents need to eat more foods rich in protein; like beans.

The LCI Chairman of Bulagazi village, Paul Nabeera, says there is a culture of people denying children eggs and fish in the false belief that children who eat these protein-rich foods will never talk.

A senior nursing officer at the clinic, Charles Mwesigwa, also sums up what he thinks are the main contributors to malnutrition in Namutumba; lack of safe water, poverty, low family planning service at 16%, the belief that they have to produce many children, poor hygiene and laziness.

“The men here do not want to work,” he says, “all the work is left to the women.”

However, the main trigger of the tragedy that caught headlines in May was the drought and hailstorm that destroyed food crops.

The office of the Prime Minister which investigated the food security situation in Namutumba district noted the same cause but, in a statement, also blamed the unplanned sale of foodstuffs, including crops in the garden before maturity, to traders from Sudan.

Namutumba, because it has been in the news, is seen as an extreme case. However, a report by USAID notes that persistent high rates of malnutrition in children under five are common in Uganda. It says 38 percent suffer from chronic malnutrition (stunting), 16 percent are underweight and 6 percent suffer from acute malnutrition. It shows that Uganda will not meet the MDG target to halve hunger and malnutrition by 2015 and says cases such as Namutumba are symptoms of the larger problems of inadequate access to food, suboptimal infant feeding practices and poor health, sanitation and hygiene practices.

Experts distinguish between urban and rural malnutrition. In urban centers the major cause is not the lack of food but the lack of basic knowledge of what to feed the child and at which stage during their growth.

In rural areas, it is a combination of lack of food, lack of knowledge, and primitive practices made worse by calamities like drought, famine, and floods.

Malnutrition contributes to about 60% of childhood deaths in the country, erodes agricultural productivity, and makes poverty worse, according to another report titled “Malnutrition: Uganda is paying too high a price”. Every one percent increase in malnutrition leads to a four percent increase in poverty.

The report indicates that Uganda loses over US$310 million in malnutrition related illness and that more than 16,000 children born weighing less than 2.5kg because of malnutrition died in 2009.

According to the World Health Organization (WHO), malnutrition is the gravest single threat to global public health. The probability of dying below the age of five in Uganda according to the WHO is 128 per 1000 live births.

Paulina Apolot a nutritionist at the Mwanamugimu Care Unit in the pediatrics section of Mulago National Referral Hospital in Kampala says a malnourished child is susceptible to many diseases because their immune system is weakened.

She says that they received over 198 cases in the month of June only and these are people mainly from the urbanised districts of Wakiso and Kampala.

She says most mothers of the malnourished children they are handling are aged 17-24yrs. “They give birth while still young and lack the basic knowledge on how to handle these children and consequently they descend to malnutrition,” she says.

Barbara Nankya Mutagubya, an administrator at Sanyu Babies Home in Kampala says that the first and most crucial step when handling malnourished babies is to take the child or children for general check up  to  determine their HIV status  and other illness.

She says that 90% of the children they take under their care are malnourished coupled with other illnesses.

“If the child does not have other medical complications, it takes a short time for them to recover from malnutrition but this is very rare because malnutrition makes the victim’s body susceptible to many diseases,” says Mutagubya.

That was the case with Janat Namulondo’s daughter, Faima Namulondo. The 48-year old mother was pregnant with her when her husband died seven years ago.

Faima was diagnosed with sickle cell anemia but was growing up normally until three months ago when her mother failed to provide food.

Seven-year old Faima became malnourished. Her arms and legs are smaller than a walking stick.

Her mother says that she was tested for HIV and found to be negative. It was when nutritionists came from Mulago National Referral Hospital that she was told the child was malnourished. She is currently receiving treatment from Magada health centre.

“I do not know what will happen to my daughter that is why I have given her my own name,” Namulondo says.

But in trying to save Faima, Namulondo was forced to abandon her two other children aged 9 and 11. When she goes back, she will probably find two malnourished children to take care of.

The special team from Mulago Referral Hospital that was dispatched to help the people of Namutumba has since returned to Kampala. But it could be asked to return if severe malnutrition erupts again because poverty, illiteracy, superstition, and teenage pregnancy have not been addressed.