Malnutrition in children: What needs to be done

During a recent training tour for health journalists in Musanze District, areas such as family planning, nutrition, non-communicable diseases and service delivery in hospitals, were among the issues that were assessed in different health centres in the district. The three-day training workshop, organised by Rwanda Biomedical Centre (RBC) in partnership with UNICEF Rwanda aimed at improving health reporting and promoting desirable behaviour through different media channels. At Muhoza Health Centre, officials revealed that efforts have been made to curb the problem of malnutrition, which remains a challenge in the area. The health centre has, for instance, taken to sensitising the community about the causes, effects and prevention measures of malnutrition. A total of 26 children at the centre were said to have malnutrition at the time of our visit. What is malnutrition? According to Venuste Muhamyankaka, the president of Rwanda Nutritionists’ Society, malnutrition can be classified into three types; lack of food intake, over nutrition, hidden hunger or having fed yet the body is unable to utilize the food taken due to diseases and other factors. The situation of malnutrition in Rwanda, according to Alex Mucumbisti, a nutrition officer at the maternal child and community health division at Rwanda Biomedical Centre, malnutrition has been going down over the years. The 2016/17 findings by Rwanda Demographic and Health Survey (RDHS) indicate that all forms of malnutrition have decreased in all the components of stunting, underweight, wasting and anaemia. He says cases of underweight are at 9 per cent, stunting at 38 per cent while anemia is 37 per cent. “However, when we compare it with the under 20 per cent rate recommended by World Health Organization, we notice that there is still more that needs to be done,” he says. Mucumbisti says the country has progressed on this cause over the years as stunting, for instance, stood at 50 per cent in 2005. Who is vulnerable? Sayinzoga says the most affected group is children under five, pregnant and lactating women. Although this is the most affected group, he says they also focus more on children under two and adults as well. “Since malnutrition normally comes with other infections, such as HIV and TB, persons affected with these conditions are also given some foods to boost their nutritional needs,” he says. The cause of malnutrition, experts say, is inadequate food intake or some diseases which can impair the function of foods one has taken. Muhamyankaka says basic causes of malnutrition are lack of knowledge and skills which they need to avoid cases of malnutrition. Poor healthcare of the child like not breastfeeding and poor early development programmes can also lead to malnutrition, he says. Muhamyankaka also says a high population density at household level, contributes especially cases where one has many children without means to feed them. Poverty also contributes to malnutrition as one lacks enough resources to take care of all their needs, including feeding. “The entire society needs to be educated on this. They should prioritise food, because we are actually what we eat and our life depends on nutrition,” he says. For Erick Musengimana, a nutritionist at Rwanda Diabetes Association, ignorance is another cause of malnutrition. He points out that if one doesn’t know how to prepare a balanced diet or how to maintain good hygiene it becomes a risk factor for malnutrition. What should be done? According to Felix Sayinzoga, the division manager of maternal, clinic and community health at RBC, efforts to fight malnutrition are in place. However, Mucumbisti says although the rate of stunting has decreased, a lot still needs to be done. “There is a lot that needs to be done concerning stunting and anaemia especially. Some interventions have already been put in place to curb the problem. There is commitment from the government to end this challenge,” he says. Sayinzoga notes that the 1000 Days campaign that started in 2013 is one of the strategies aimed at reducing stunting and anaemia. The campaign has five main components which focus on pregnant women, breastfeeding, vaccination and immunisation, complimentary feeding and hygiene. Each component, however, has many activities that have been put together to ensure the reduction of the two types of malnutrition, he says. Another strategy, Mucumbisti says, is the implementation of home fortification, commonly known as “hongera bingamubiri” in Kinyarwanda, where micronutrient powder is given to all children between the ages of six and 12 for three months. “Already, 19 districts have been covered, and the remaining 11 are being trained. By the end of this month, the Ministry of Health is expecting to be done with all the districts so that it becomes a national programme,” he says. Mucumbisti notes that data on stunting shows that children under the age of two are the ones who have a big problem when it comes to stunting and anaemia. “That’s why complimentary feeding is important and has already been put in place. The government is now giving fortified foods to all the children in the country under the age of two, as well as lactating and pregnant women every month,” he says. Knowing the foods to eat keeps malnutrition at bay. Consequences of malnutrition Musengimana notes that the most alarming consequence of malnutrition in children is stunting. “There is cognitive impairment of the brain and physical growth. For instance, a child can have problems in school of understanding or not catching up easily with others,” says Muhamyankaka. Physical growth is also affected, which can affect the productivity of a child in general, he says. Muhamyankaka further points out that anaemia is also a malnutrition problem which is brought about by lack of iron. “This can be manifested in loss of hair, lack of concentration, fatigue, headaches and other gastrointestinal problems,” he says. Muhamyankaka explains that unlike anaemia which can be cured, stunting cannot. Once a child is stunted, there is nothing that can be done. Way forward Sayinzonga says the prevention of malnutrition starts when the mother is pregnant, adding that following all instructions by their gynecologists is vital. “Focusing on the first 1,000 days of the child’s life (from conception to the second year) is important. In this period, the child needs to be well-nourished to avoid incidence of malnutrition,” he says. According to Muhamyankaka, eating the appropriate food at the appropriate time is important. “The food should be balanced and other micronutrients foods such as those rich in folic acid, especially for pregnant women, should be consumed. “After birth, the child should be breastfed exclusively for six months then complimentary foods should be introduced,” he says. In Rwanda, Muhamyankaka says, only 17 per cent of mothers breastfeed exclusively for six months, which remains a challenge also when it come to fighting malnutrition. Musengimana, however, says eating right is the best way to prevent malnutrition in general. Experts share tips Robert Mugabe Robert Mugabe Butera, the chair person of the Civil Society Alliance Rwanda Malnutrition is multidimensional. There is no single solution that can be used to fight it, so there is need for different approaches to overcome it. For instance, both the husband and wife have a task to ensure their baby is healthy from the time of conception up to two years of its life. Iba Mayale Iba Mayale, gynecologist at Doctor’s Plaza, Kimironko Pregnant women should ensure they attend all the antenatal visits as advised by their obstetricians, as well as take folic supplements. Breastfeeding the baby is important after delivery as the first milk has cholesterol that contains lots of nutrients which are essential to the baby. Gonzalue Niyegaba Gonzalue Niyegaba, medic at University Teaching Hospital Kigali (CHUK) To avoid cases of malnutrition, one should start right from conception. Mothers should be educated on what to do and what to avoid while pregnant. Taking fresh milk daily as well as maintaining a balanced diet is ideal for those who are malnourished. Olivier Habiyaremye Olivier Habiyaremye, general practitioner Practicing good hygiene, vaccinating pregnant women and children, exclusive breastfeeding and also educating mothers on different issues including how to have kitchen gardens at their homes, cuts the cost of buying nutritious food as it also ensures the family has foods that contain nutrients, thus preventing cases of malnutrition.