Undernutrition contributes to nearly half of all deaths in children under-five globally, with sub-Saharan Africa suffering disproportionately. Undernutrition results in suboptimal growth, and makes it difficult to resist infection and recover from common childhood illnesses, such as diarrhea and respiratory infections. Children who are undernourished often suffer from delayed cognitive development and long-term health issues such as diabetes and heart disease.
Over the past decade, Rwanda has made significant strides in reducing child malnutrition. Acute malnutrition has dropped from 5% in 2005, to 2% in 2015, significantly reducing a form of malnutrition that puts children at an increased risk of dying. Stunting remains a concern in Rwanda with 38% of children under-five stunted.
We are working to eliminate child deaths due to severe acute malnutrition in the districts we support. Malnutrition is a cycle: an undernourished pregnant woman is more likely to delivery an underweight infant, who is at increased risk of becoming an undernourished child, and eventually a malnourished adolescent and adult. If that is an adolescent girl or a woman, the cycle of undernutrition continues into the next generation. The First 1,000 Days campaign initiated by the government in 2012 is aimed at ending this cycle by targeting a critical period of growth and development, where the risk of undernutrition is heightened. Particularly, pregnancy, lactation and the first 24 months of life are periods during the life cycle that are most vulnerable to the effects of undernutrition.
Training and Mentorship at Health Centers
The Community Management of Acute Malnutrition (CMAM) has revolutionized the treatment of malnutrition in developing countries. Rather than admitting children to inpatient hospital units to treat malnutrition, children and their caregivers can now remain in their communities and households while receiving treatment. This leads to decreased risk of acquiring infections in the hospital, decreased economic losses when the caregiver can continue their daily activities, and decreased stigmatization of malnutrition. We train more than 90 health center providers annually on CMAM to improve the quality of care of malnutrition services.
We have found success with our mentorship program to improve the quality of care in maternal and child health services. Our mentors accompany nutritionists and child health nurses at health centers to improve the treatment provided to children under-five who have acute malnutrition. By improving the quality of care, we are ensuring that children are admitted, treated and discharged from the malnutrition program according to best practices.
Enhanced Prevention and Treatment of Maternal Malnutrition
The nutritional status of a child’s mother can significantly impact the infant’s health, and ultimately the child’s opportunity for normal growth and development. Infants born to mothers who are underweight are more likely to be born with a low birthweight; a major cause of newborn mortality. In order to improve childhood growth, early, timely, and comprehensive antenatal care is essential. We work to ensures that health providers monitor for development of malnutrition. Mothers identified as at risk for malnutrition start on vitamin and mineral supplements early and are provided opportunities to receive nutrition education and counseling throughout her pregnancy. We are developing a training curriculum on Community Management of Acute Malnutrition with a focus on maternal nutrition. This curriculum which will be followed up with continued mentorship will ensure women diagnosed with malnutrition during pregnancy and lactation are receiving comprehensive care. Strengthening of maternal health services at the community and health center level will improve maternal undernutrition and ultimately childhood undernutrition. Our training of health providers on maternal nutrition will ensure that providers of antenatal and postpartum care are confident and comfortable in delivering health and nutrition messages.
Training at District Hospitals
Some children require a higher level of care due to infection or other medical complications. Ensuring that hospital health care providers are providing the highest quality of care to these patients is essential to eliminating mortality from malnutrition. Nurses, doctors and social workers treating patients with acute malnutrition in the hospital are trained by our staff annually on evidenced-based practices to ensure the highest level of care to this vulnerable population. Through case studies and lectures, training participants are equipped with the knowledge and skills to ensure a high level of expertise in treating malnutrition.
Pediatric Oncology Patients
Children receiving treatment for cancer are a uniquely vulnerable population. Children with cancer are at a higher risk of developing malnutrition due to the nature of their disease. Malnutrition can negatively impact response to cancer therapy, impair muscle function and physical performance, and ultimately may impact survival. Children and adolescents are particularly vulnerable to development of malnutrition due to their needs for growth and development during this time. We have trained health providers of pediatric oncology patients at the Butaro Cancer Center of Excellence in concepts of nutrition specific to cancer patients, and are improving screening and diagnosis of malnutrition to lead to individualized treatment and care. We are supporting research in this area to better understand the affect of malnutrition in this population and developing innovative strategies for treatment.
Training Community Health Workers
Community Health Workers (CHWs) are the first line of defense in identifying children with malnutrition in the community. We train CHWs in the three districts we support on best practices related to nutrition. During monthly growth monitoring, CHWs visit households with children under-five to screen for malnutrition and refer those at risk to health centers. CHWs are key to providing education essential in the prevention and treatment of malnutrition to caregivers such as increasing uptake of exclusive breastfeeding, positive feeding practices for infants and children, and improving sanitation and hygiene in the home. CHWs lead monthly cooking demonstrations for community members to improve the nutritional quality of the diet at home.
We are striving to reach all levels of the health system, from the community to the hospital level, targeting both prevention and treatment of undernutrition. No child should die from malnutrition and with the well-documented negative impact of chronic malnutrition, we have an important task ahead of us. We are partnering with the government and other organizations working in Rwanda to reduce undernutrition, thereby creating a healthier, more productive population. As noncommunicable diseases become increasingly more common in developing countries we are determined to address all forms of malnutrition and aim to reduce the potential increase in these nutrition-related diseases.