COMMUNITY HEALTH – DEVELOPMENT AND IMPLEMENTATION OF NUTRITION INTERVENTION TO ERADICATE MALNUTRITION IN NORTH-EAST GONJA DISTRICT

Background

Malnutrition remains a major cause of disease and death among children under five years of age. Malnutrition is an imbalance in nutrient requirement and intake that negatively affects growth and development. An estimated 13.6 million children die annually from under nutrition globally and in 2016, stunting accounted for malnutrition burden of an estimated 39% of children under five years while wasting accounted for an estimated 27% of this burden.

Ghana is making great strides to meet the global targets for under-five underweight, stunting, and wasting. Despite appreciable reductions in malnutrition rates significant numbers of people in Ghana, especially children are still affected by the burden of malnutrition.

In Ghana, malnutrition is prevalent and has been reported as a major risk factor for disability and deaths combined. Underweight, wasting, stunting accounts for 10.4%, 5.3%, and 18.4% of the burden of malnutrition in Ghana among children under 5 years respectively

One child in every five in Ghana experiences stunted growth during the first thousand days of life caused by inadequate nourishment, frequent illness and an unhealthy environment. These affect the physical, social and cognitive development in children. Their brain development is negatively impacted which further affects learning at an early age, school performance and ultimately their socio-economic development.

Limited knowledge of key infant and young child feeding practices among caregivers remains a challenge in the country. This coupled with the lack of skills to prepare nutritious foods and the cost of certain foods, leads to poor diversity in the diets of infants and children. Additionally, the widely held perception that infants can easily swallow and digest only porridges made from starches and grains is resulting in the low intake of iron-rich foods.

The rate of exclusive breastfeeding (giving children only breast milk in the first six months of life)  has however stagnated over the last decade at 52 percent, although over 95 percent of women breastfeed their babies in the country. Additionally, only 13 percent of children between 6-23 months receive the appropriate minimum diet diversity. Indeed, the gains made are not equally distributed across all areas of the country and across all categories of women and children, with wide geographical and socio-economic disparities.

This is largely because interventions have not been implemented at scale in all parts of the country in a sustainable and coordinated  manner across relevant sectors. The Northern regions in Ghana happen to be some of the pertinent underprivileged regions in Ghana. This informed our decision to choose East Gonja District as the project site.

PROJECT OBJECTIVES:

1. Support registration of National Health Insurance Schemes (NHIS) for malnourished children;
2. Support feeding and medical care for in-patient and out-patient clients;
3. Create awareness in the various communities on the menace of malnutrition;
4. Hold advocacy meeting with traditional/spiritual leaders and chiefs in the communities on child malnutrition and its consequences;
5. Case search for malnourished children for prompt management and medical attention; and
6. Equipping nutrition officers with assessment tools for work effectiveness.

SUPPORT REGISTRATION OF NHIS FOR MALNOURISHED CHILDREN

Malnutrition affects children 6 months to 5 years. The immediate cause of this condition is inadequate dietary intake, poor dietary practices and frequent illnesses and disease. When a child is identified as being malnourished, it is also anticipated that the child has an infection which should be treated. Treatment of these infections require primary medical care which involves giving the child the first line dose of antibiotics, amoxicillin. These children are also screened to rule out infections such as malaria and HIV/AIDs. Most often, some of these children are not covered under any medical insurance plan and this makes it difficult accessing healthcare especially those with medical complications who need admission or in-patient care.

Acquiring the health insurance for these children will go a long way in giving their parents and guardians confidence, when referred to seek medical care at the higher facility (District Hospital) since they are sure their medical bills are would be covered.

SUPPORT FOR FEEDING

Malnourished children are fed with high-end nutritional foods such as Ready to Use Therapeutic Feed (RUTF), F-75, F-100 and Resomal. Apart from RUTF, all the feeds are used within the health facility.  These are all tailored to their specific conditions to prevent complications such as refeeding syndrome. Therapeutic feed (F-75 and F-100), RUTF given to parents for continuous nutrition enhancement at home (after discharge), F-100 and Resomal have been out of supply making it difficult to have a comprehensive care plan for these malnourished children, placing them at a higher risk of infant mortality. 

When a child identified to be malnourished is referred to the higher level based on his/her medical history, F-75 is used in the stabilization phase and F-100 during the rehabilitative phase. Due to shortage in supply, caregivers are allowed to provide powdered adult milk, vegetable oil and sugar to allow an improvised version of these therapeutic feeds to be prepared for them by the nutritionist or dietician. For children less than six months who are wasted with a weight of less than 4.0k.g, F-100 diluted are often used and this also have to be prepared commercially. Most at times, parents (mostly single mothers) are unable to provide these items needed for the baby’s survival.

Aside feeding these children with the therapeutic feeds, family foods rich in the nutrients at its right proportion should also be fed to the children. Caregivers and mothers of these children are faced with a challenge of providing these nutritious foods. Additionally, these children find themselves in a large households and often with, parents who are not working. All these factors contribute to the children’s inability to meet their nutritional requirement. These children relapse and are placed on the program three times in a year. Unfortunately, the social welfare services are unable to sufficiently support all the children requiring such support.

FOCUS GROUP DISCUSSIONS (TRADITIONAL/SPIRITUAL LEADERS AND CHIEFS IN THE COMMUNITIES)

Communities have a lot of traditional/spiritual and prayer camps which are ingrained in the fabric of the society. However, these environments believe malnutrition is a condition caused by witchcraft or someone with a “bad eye” looking at your baby bump whilst pregnant or when you dry your baby clothes outside. These are myths that needs to be addressed through frequent health education and advocacy.

Caregivers and mothers are more likely to send their wards to these prayer camps and spiritual homes when they realize children are severely losing weight with visible signs of wasting, and at times, when the child swells up as a result of fluid accumulation (oedema). Most leaders are not aware that this condition is a medical and nutritional problem. Educating and forming partnership with them will help in the reduction of cases that come to the health facilities, especially in terms of severity and also ensuring early identification of these children for further management and treatment.

This will help in creating awareness about the condition as these community leaders add their voices to the campaign.

Considering the critical role Chiefs, traditional/spiritual and prayer camp leaders play in our communities, bringing them on board will help greatly in addressing the challenges and issues surrounding malnutrition, hence leading to malnutrition reduction and thereby giving every child the opportunity to grow healthy.

CASE SEARCH

Early and continuous screening of children to assess their nutritional status using the MUAC tape, infantometer, child health records and physical observation helps in the prompt management of those who are malnourished. This also serves as a means to prevent the onset of the condition amongst those at risk of being malnourished. Many caregivers even hide these children in their rooms with the impression that the condition is a spiritual one. Case search is the primary preventive measure of ending malnutrition.

HEALTH ADMINISTRATION

**CHAG – Christian Health Association of Ghana

**CHPS – Community Health-Based Planning Services

PICTURES OF SOME OF MALNOURISHED CHILDREN