Fish on Monday, ground nut stew on Tuesday, vegetables on Wednesday, beef on Thursday... to some, this is what makes a balance diet. It is the ultimate ‘proper nutrition.’ The idea that one can be malnourished despite seemingly eating ‘well’ will not hold to this school of thought. Not so to a dietician or nutritionist at that.

Malnutrition is the condition that results from eating a diet in which certain nutrients are lacking, in excess (too high in intake), or in the wrong proportions. 

"A balanced diet means getting the right types and amounts of foods and drinks to supply nutrition and energy for maintaining body cells, tissues, organs to support normal growth and development,” says Christine Murebwayire, a nutritionist at Kibagabaga Hospital.

"Most people do not feed appropriately because they don’t have enough money to buy the foods they need. Some foods are usually expensive and a poor person can hardly afford them, so they eat what they have.”

Whereas some people don’t have money, there are a number of wealth people without knowledge on the principles of right feeding or what kind of food the body requires to grow healthy.

"This is evident in the way that people think having a lot of expensive junk is the right way to feed, this conviction is definitely a wrong one,” says Hassan Habimana, a paediatrician at Kibagabaga Hospital. 

However, there are people who have a lot of work to deal with hardly enough time for themselves, not even for their children, this can be a deadly venture as Immaculate Uwitonze narrates about her son Ismail Kanyanguga, 

"I arrived from a four-month sabbatical eagerly looking forward to seeing my 3-year-old son. All I wanted was to hold Kanyanguga in my arms but I was taken aback by what I saw.

"He had changed, looking bloated and when I tried to lift him up, he responded with a frail cry. His face was pale, the skin peeling away with the white towel as I rolled it over...” 

The maid was adamant the boy had not been sick lately. I rushed him to hospital and after examination, the doctor explained that the swelling was oedema, a sign of protein energy malnutrition (PEM).

Experts view on malnutrition

According to the Pan-African Medical Journal, 2013, malnutrition contributes to more than half of deaths in children worldwide. Child malnutrition was associated with 54 per cent of deaths in children in developing countries in 2001.

It is estimated that nearly 30 per cent of infants, children, adolescents, adults and elderly in the developing world are suffering from one or more of the multiple forms of malnutrition, 49 per cent of the 10 million deaths among children under five each year in the developing world are associated with malnutrition, another 51 per cent of them associated with infections and other causes.

Health minister Agnes Binagwaho, in a 2012 report titled, "Uniting to uproot malnutrition,” said:

"The rate of stunting among children under the age of five was found to be 51 per cent in 2005; by 2010, it was still far too high at 44 per cent. Over the same timeframe, the prevalence of underweight had declined by roughly 30 per cent, from 18 per cent to 11 per cent of children. Based on this and numerous studies by the Ministries of Health and Agriculture, it was clear that the driver of persistent malnutrition was not a lack of sufficient food, but a complex set of social, cultural.”

Dr Habimana says malnutrition in communities is basically caused by lack of enough nutritious food. In other situations, parents do not have time to feed their children but leave them in other people’s hands to cater for everything, including meal supervision.

"If the meals are not good, malnutrition begins to manifest andthe most common type is protein energy malnutrition, commonly known as kwashiorkor,” he adds.

Most parents do not realise that their children are sick until they have swollen areas on their bodies a condition known as oedema.

Protein energy malnutrition can also occur in breast-feeding infants. This occurs in mothers who lack enough milk which may be caused by lack of enough food forcing them to take only water which is not sufficient enough to allow formation of breast milk.

Typical manifestestation of PEM begins with loss of weight, brown silky hair, body swelling with fluids (oedema), peeling of the skin, ‘moon-face,’ among others.

Nutritionist Murebwayire warns that parents should not confuse oedema with normal fattiness.

"Some parents think that when the child swells, it is gaining weight. This is wrong since visible swelling in this case (oedema) is a common symptom of PEM, which results from fluid accumulation in the body,” the nutritionist says.

Our bodies need essential proteins which are obtained from food sources such as eggs, milk, meat, beans, peanuts for growth, cell reconstruction, wound healing. 

Failure to provide these proteins to the body forces it to resort to stored proteins, including those surrounding the nerves. Among these is albumin, which has a role of containing the water and when it is used up, the water moves out of the cells causing abnormal swelling. 

Causes of PEM

Specioza Mugwaneza, a nursing assistant at the children ward in Kibagabaga Hospital, says most people think that poverty and lack of enough food are the lead causes of malnutrition, which is not the case.

Some people have the food and money but fail to have sufficient time at their homes to facilitate acquisition of proper meals as well as monitor the feeding patterns of their children.

"Ignorance results into poor nutrition where by some parents may lack enough knowledge on the suitable methods of meal preparation that may enable conserving nutrients,” adds Dr Habimana.

"The biggest worry is that even when some people provide these meals, they are not balanced. For example, some women bring their children here for nutritional rehabilitation after spending months weaning them on starchy porridges, especially cassava porridge.

"This is wrong as this porridge cannot offer any other kind of nutrient besides loading the body with starch, hence lack of a balanced diet is the leading cause of malnutrition,” Mugwaneza says.

What constitutes a good diet?

According to Murebwayire, a good diet should have body building foods, energy giving foods, protective foods and water. 

For example, a normal meal should at least have a fruit or fruit extract, a vegetable, a carbohydrate, a meat product, and water. 

The vegetables provide the fibres that help prevent constipation, the proteins and minerals come from the meat products and some from the vegetables, while the vitamins come from the fruits, and the carbohydrate provides energy. 

A typical health diet may include potatoes, fish, cabbage, ovacado, water, passion fruit juice.

How to prevent malnutrition

Winnie Kaibanda, whose child was rehabilitated for malnutrition, started backyard gardening and says it has done wonders. 

"I use this small space in my backyard for growing vegetables. I don’t provide the vegetables alone since the doctors advised me to mash silver fish along with potatoes in my baby’s food,” Kaibanda says.

But Dr Habimana insists that the biggest way to tackle malnutrition is by educating people at the community level. People need to know what constitutes a good meal, how should meals be prepared in order to conserve the nutrients. 

Murebwayire says: "Preparation methods such as steaming vegetable may preserve some heat-sensitive vitamins. While a meal should be a combination of many foods, a good meal is a combination of many nutrients. One may lose out on them simply because of poor food preparation.”

As part of the diet, fruits should be included as these are a good source of vitamins and minerals like the nutritionist advises.

"People should monitor persons who stay their children. Child care should not be taken for granted as not everyone will offer the best to your children, like a care taker who has his own child will definitely offer the best to his or her child and the balance is what will go to your child,” Dr Habimana says.