At the age of four-and-a- half-years, Theogene Dukuzumurinyi was admitted at Kibagabaga Hospital in critical condition. His body was in a dire state with a swollen lower limb, depleted muscle fat mass and grade three oedema (when you press the skin it forms a depression). Luckily for Dukuzumurinyi, nutritionists and health experts at the hospital were quick to identify the problem and gave him the necessary rehabilitation.

"The lower limbs and feet were swollen, the skin was pitting, muscle fat store was depleted (fat content was empty) until when he was admitted here. We have now discharged him after one month, and he is in a good condition,” says Isaac Bikorimana, a nutritionist at Kibagabaga Hospital.

Although initially Dukuzumurimyi’s mother mistook the disease for witchcraft, Bikorimona points out that it was a case of severe acute malnutrition.

However in worse cases, infants could suffer chronic malnutrition. Unlike this acute form, individuals with chronic malnutrition appear to be stunted proportionally but actually shorter than normal for their age or height.

The condition is associated with a high death rate, affecting 4 per cent of children under the age of five and stunting is one of the major problems in this age group.

From the recent EICV household survey, at least 51 per cent of children under the age of five were stunted in 2005, but the prevalence rate of stunted children gradually declined over time to about 38 per cent in 2014/15.

Efforts to curb stunting further by the government are underway but also the civil society has joined hands.

At a recent workshop in Kigali, a campaign was launched under the theme; ‘Scaling up nutrition’ (Sun).

The campaign sponsored by the Civil Society Alliance (CiSA),UN, government, donors and private sectors to fight malnutrition brought together stakeholders to discuss strategies of ending chronic malnutrition that was evident from various studies.

While presenting Rwanda Demographic and Health Survey (RDHS) Svein Langeland, the representative of ONE UN Renewed Efforts against Child Hunger and under nutrition (REACH) project, explained the situation in the country.

Rutsiro was cited as the hardest hit districts in the country with the highest number with 51 per cent of children under the age of five suffering from chronic malnutrition. This was closely followed by Rubavu with 48.3 per cent, Ngorero with 48 per cent, Nyabihu with 46 per cent and Bugesera with 41 per cent.

Although efforts of bringing this malnutrition down are immense, most experts link this condition to the lack of complimentary feeding in children.

Robert Mugabe Butera, the chairperson of CiSA Rwanda, explains that through clear strategies, it is possible to eliminate chronic malnutrition."The SUN CiSA-Rwanda is an important new mechanism which will advance Social Mobilization, Advocacy, and Communication (SMAC); align strategy; and promote collaboration across organizations and sectors to sustainably address malnutrition,” explains Butera.

Dangers of poor nutrition

According to Rene Tabaro, a nutritionist at King Faisal Hospital, chronic malnutrition results into chronic deficiency of nutrients in the body and that’s is why it is commonly referred to as under nutrition.

"Deficiency can be of any one or more nutrients like carbohydrates, vitamins, proteins, minerals and fats,” Tabaro says.

He, however, warns about consuming excess nutrients as not being any different from poor nutrition.

"Even over nutrition like excess consumption of calories (obesity) is also poor nutrition. The problem mainly affects children under the age of five years,” he adds pointing out that:

"Chronic malnutrition starts when a pregnant woman doesn’t take the required nutrients as the possibility of giving birth to a child who is underweight is very high. Babies born underweight are normally likely to have chronic malnutrition”

Causes

Dr Protais Munyarugamba of Harmony Clinic in Kigali blames chronic malnutrition on poverty, ignorance about essential nutrients, chronic infections and illness, intestinal worms, thyroid disturbances, uncontrolled diabetes, malabsorption syndromes and eating junk foods.

"If a child has intestinal parasites or often suffers from diarrhoea, the child will not be able to take in all the required nutrients of the food. Again, if the pregnant woman is undernourished, the unborn child will also not receive all the necessary nutrients it needs to develop to its full potential,” says Munyarugamba.

Tabaro further observes that too short a breast feeding duration could risk malnutrition.

"Not breastfeeding the child exclusively for a period of six months, results to the child developing chronic malnutrition. Mothers who start giving their children supplementary foods either earlier before or late after seven months expose the children to develop the condition,” he emphasizes.

Dr Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital, warns that delayed treatment of chronic malnutrition can even cause heart failure and subsequently multi-organ failure.

According to Dr Pande, there is need to watch out for signs and symptoms such as; fatigue, weakness, aches and pain, puffiness over the face and swelling over the feet, breathlessness on walking, abnormal sensation on feet and hands, dry coarse hair, dryness of the skin and cachexia.

"In some cases, the child’s weight may become fixed, their immunity also becomes low and this may lead them to be more prone to some diseases such as marasmus, malaria, pneumonia and many others. They also cease to grow at a certain point,” she adds.

Managing malnutrition

Munyarugamba says there are some products that are used in treatment of chronic malnutrition, and if followed well as prescribed by physicians, then the condition can be treated and the child can live a normal and healthy life like others.

"Some food supplements such as sosoma2 fortified and plumpy nuts are the main cure for people suffering from chronic malnutrition, the improvement may be quite slow but it’s effective. "Taking fresh milk daily and maintaining a balanced diet is also ideal for the treatment,” advises Munyarugamba.

Pande also points out that prevention lies in good food and body hygiene. She says one should make sure their diets include whole grains, fruits, vegetables and cereals, milk and milk products as well as fish.

She adds that, freshly prepared fruit juices are better than sodas and bottled juices. And that one should avoid junk food and alcohol.

Tabaro also points out that vaccinating pregnant women and children, exclusive breastfeeding, educating mothers on how to have kitchen gardens for planting vegetables helps to overcome this type of malnutrition.