Forging non-traditional stakeholder partnerships

against malnutrition

Resources for Improving Birth Outcomes - RIBO

Dr. Pamela Mukaire

CCIH 29th Annual Conference, 2015 – Washington, DC

Food, Health at Birth and During Infancy

• Fetus nourished at the expense of mother’s tissue, IF NECESSARY

• Mother’s childhood nutrition (her height) affects her child’s birth weight

• Mother’s diet during pregnancy affects birth weight

• Poverty-stricken communities – birth weight increase when mothers diet is improved

• Increased birth weight = increase in infant/child survival rates

• Well nourished babies – healthy babies, health communities

• Nutritional deficiencies cause increased child mortality

The Malnutrition Problem in Uganda

• Malnutrition is a key variable of the three related welfare dimensions of monetary poverty, food security and nutrition

• Malnutrition is associated with more than half of all childhood deaths worldwide, • poor child-feeding practices, • food shortages or • poor access to adequate sanitation and healthcare.

• Most vulnerable • young children, women, the elderly • people with chronic illnesses e.g. HIV, TB, cancer etc.

• Uganda 12% of children under age 5 are moderately or severely underweight

A Burden or Challenge?

• 2013 WHO study• Over 400 MCH healthcare providers interviewed • Key finding: Infant feeding challenges – largely due to lack of

food• Majority of providers identified malnutrition as a big concern –

both in HIV exposed and unexposed infants & children• Of the 400 interviewed, ONLY 1 Clinical Officer personally

took up the challenge to mobilize the community to address the malnutrition treatment service gap!!!

• Sister Proscovia Menya – Clinical Officer

• “Nurse, here are your children” - Underweight (low weight for age), wasting (low weight for height), and stunting (too short for age), cases in HIV-exposed babies especially.

• Burden or challenge? – home made soy milk inspires community-based malnutrition management project.

Partnership Roles

Midwives & Nurses: clinical assessments

VHTs: case identification, referral, outreach, follow-up

Community members: garden care and management

Academia: Researchers to assist with CBPR, community and home based nutrition assessments, data collection and tracking

ALL: work in the garden, outreach, garner resources

Programs Services

• Nutritional status screening - (moderate or severe, acute) and HIV status

• Health nutrition services, counseling and education outreach – integrated for HIV, TB, FP, nutrition, immunization, de-worming

• Promotion of breast feeding

• Growth monitoring promotion and infant and young child feeding

• Home-based care

• Clinic/community managed vegetable garden.

Highlighting the Community Garden

Sister Proscovia Menya

Second Garden Nursery

“Container” Garden for backyard farming

Highlighting the Community Garden

Kyiimaka HC 2 – Second Garden Nurses and Community Mother & Father

How Resources are Mobilized.

Community

Father

Clinical Officer, and Nurses

• Year 1- Thriving gardens, food preparation demos, and growth monitoring

• Year 2- Different reasons and goals for partner members

• Funders fail to tap into potential community power

• As supporters – ask, “how best to contribute to this power that resides with the community to solve its problems

• Year 3- Back to Community-Based Malnutrition Management of Acute Model (CHAM)

Partnership expectations

• Lack of gardening tool - no hoes, watering cans, horse pipe, etc.

• Cooking demonstration equipment - no mortal, buckets, water jerricans, charcoal, stove, saucepans for cooking, warming and storing milk, food warmers

• Poor documentation of success - lack of camera, record keeping

• Basic clinical assessment tools- tape measures, weight scale and boards ….

• VHTs training updates

• Lack of ready to use foods for those with severe nutrition

Resource Challenges – Kyiimaka HC 2

New Partner

Resources for

Improving Birth

Outcomes

Resources

for

• The mission of RIBO is to work collaboratively with institutions of health and academia to improve maternal and child health outcomes and general population health and well-being. We achieve our mission through three basic activities: research, education, material provisions and advocacy.

• Small group of “young professionals” – interested in contributing to and supporting local MCH efforts in semi-urban and rural

• 2 individual programs, 3 HCs, and 3 churches

Why Community-based Management of Acute Malnutrition (CMAM)?

• Apart from main hospital – no known nutrition rehabilitation center in this county

• Hospital very expensive and hard to reach for most mothers (who are the primary home care takers can’t stay away from home for too long)

• “Although children suffering from medical complications like hypothermia, hypoglycemia or severe dehydration are still sent for inpatient care at hospitals, CMAM brings brought treatment for malnourished children directly into the home.”

• Creates models of care, community support and builds social capital

STRENGHT in partnerships

• Division of labor

• Contribution of resources

• Dialogues of courage

• Shared knowledge and skills – share new knowledge, improve skills, learn simpler ways to best accomplishing goals

• Support system of people who understand the challenges of the community and are able to address new problems as they arise

• Program ownership by the community empowers mothers and their spouse far more than a clinic based model does

• We monitor each other and all grow from collaboration …

The rewards of persevering

• Its depressing to see malnourished mothers- underweight, sickly babies, not healing quickly for mother, constant anemia, and wasting.

• Seeing babies and mother gain weight and return to normal duties

• Seeing the community take ownership of the project and utilize their own resources

THANK YOU!

Questions and Comments Please!