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Field Article Figure 3: Communal (active) screening / health facility based (passive) screening Poor general condition ≥ 1 sign of serious condition Active community screening Age < 6 months Breastfeeding problems Poor suckling ability Referral CS Testing for bilateral oedema Bilateral oedemas MUAC child > 65 cm MUAC < 12.5 cm Mothers are advised and shown how to prepare the enriched porridge for their children at home and to give them the porridge twice a day in addition to family foods. Depending on availability (through the World Food Programme supplies), there is a weekly distribution of premixed food (Corn Soy Blend (CSB), sugar, oil, salt). Anthropometric measurements of these children are taken and recorded weekly and a child is discharged from the programme in accordance with either option 1 or 2 (outlined above under SAM management). Although option 2 is less reliable, most facilities supported by Fondation Tdh adopt this approach. Programme monitoring This monitoring report is based on data collected over a period of 36 months (1st January 2008 to 31st December 2010) from CMC Ratoma and CMC Flamboyant. Additional data were collected over a 12- month period (1st January 2010 to 31st December 2010) from two CS in Ratoma Commune – CS Wanindara and CS Lambandji. Data from St Gabriel (Matoto commune) were not available for analysis. A total of 7,033 cases of malnutrition in children 0-59 months were treated by the four health facilities during the period under review. Of this number, 2,343 (33.3%) presented with SAM, while 4,690 (66.7%) were treated for MAM. Of the total number of children treated for MAM, 162 (3.5%) were 11.0 cm or 80% (-2 SD)>WH>70% (-3SD) and No bilateral oedema MUAC Testing for bilateral oedema Weight for Height (WH) Referral CNS Cases referred CS (passive screening) MUAV < 11.0 cm or WH
Field Article there were external factors beyond the control of the programme managers despite their efforts to contain them. These factors included the regularity of mothers at the twice-weekly cooking demonstration sessions, quality and quantity of food which they gave to their children inbetween the twice-weekly visits to the health facilities and episodes of illness like malaria, diarrhoea or respiratory tract infections. Efforts to contain these external factors included: • Home visits for defaulting mothers by CHWs • Support to mothers of children during an episode of illness • Distribution of premixes (CSB, oil, sugar and salt) to mothers of MAM children after each weekly cooking demonstration in the health facility when available. The role of mothers in the management of moderate acute malnutrition The compliance of mothers to advice on the preparation of enriched porridge, feeding practices at home and their attendance record at the twice-weekly food preparation demonstrations played an important role in the favourable exit outcome of moderate acute malnutrition. Despite the challenges of increases in the prices of basic foodstuffs, many mothers were able to mobilise resources to purchase ingredients and prepare enriched porridge for their children irrespective of supplies of premix via the programme. Conclusions Government health facilities when given the appropriate technical, material and equipment support can deliver good results in the management of MAM cases. On the job training and supervision, feedback on performance and regular higher level supervision of nutrition activities played an important role in the quality of results posted by the four health facilities that were considered in this study. To many mothers, MAM is not an illness and compliance with treatment, particularly when it requires weekly presence in a health facility, is a challenge. The multi-pronged approach of community sensitisation, information and education, home visits and facility-based management of MAM children through weekly weighing and cooking demonstration adopted by Fondation Tdh and the authorities of the health facilities of the project, improved the knowledge of mothers about acute malnutrition in general, and MAM in particular. Cooking demonstrations that included feeding MAM children in health facilities and education and counselling on good household infant and young feeding practices were acceptable services to mothers. Compliance with treatment and the recovery rate was high and the rate of default was low. Lack of knowledge amongst mothers on appropriate feeding practices is likely to have been a significant factor in causing malnutrition in those children admitted to the MAM programme. The role of UCHWs is pertinent even where there is a wide network of private and public health facilities. Through the active screening of children in their homes in the quarters, many children who otherwise would not have been brought to the health facility because they were not perceived as being ill by their mothers, were identified and sent to the health facility for treatment for MAM. Finally the management of MAM in an urban setting demands a multi-pronged approach that involves trained health workers, community health workers, information education and counselling of mothers, good supervision and an adequate level of food security. For more information, contact: Dr. Abimbola Lagunju, email: abimbola.lagunju@tdh.ch and Dr. Jean Pierre Papart, email: jeanpierre.papart@tdh.ch Dedication to Kari Noel Egge Shared by two of her close friends and colleagues, Mary Lung’aho and Jennifer Rosenzweig As we went to print, we heard the sad news of the premature death of Kari Egge, whom many of you will have had the privilege of knowing and working with. Kari graduated from Mahtomedi High School in 1985 and George Washington University in 1989. Kari earned a PhD in Public Health from Tulane University where she combined studies with HIV/AIDS- related projects. In the following years, Kari dedicated herself to international causes. Her career in humanitarian aid work spanned over 20 years with Peace Corps, Catholic Relief Services (CRS) and the International Division of American Red Cross (AmRC). As part of CRS’ Emergency Response Team, she played a key role in numerous emergencies, including the Goma volcano disaster, Afghanistan, Southern Africa drought and the tsunami in Indonesia. In addition, Kari helped train hundreds of emergency responders. Her last posting was to Thailand, working with those in countries affected by the 2004 tsunami. During her career, she made lasting friendships around the world. Kari was also a loving mother to Dylan (6) and Isabelle (8), taking every opportunity to introduce them to new cultures and environments. There has been a huge outpouring of tributes on Facebook from a global community of colleagues and friends who supported her through her illness and are now celebrating her life. Here are just a few: “Kari will be greatly missed. Her enthusiasm and passion for improving the humanitarian cause will continue to inspire all of those who the pleasure to work with her.” “She was articulate, strong, and sensible and clearly had the experience to back up all the contributions she made”. “A mom who managed to become an amazing mother and still contribute to the humanitarian field for a long time. This affected me profoundly and I know I made decisions differently because of her example. It is amazing how much impact Kari’s life had, not just on her immediate family who were blessed by her love and mourn her departure, but also on those of us who were merely in her presence and felt changed by her life and the way she chose to live it.” Some lovely memories are also shared at http://thegeographyofsoul.wordpress.com/201 2/01/31/kari-noel-egge/ There will be gatherings for her and celebrations of her life happening around the world (Minnesota, Washington DC, Kenya and Bangkok). This speaks to the incredible impact that she has had on the world. We express our sincere condolences to her children, Dylan and Isabelle, on their loss, as well as to their father, Graham Eastmond, her parents, Robert and Deanna Egge, brother Kirk and family. Mary Lung’aho, Jennifer Rosenzweig and all of the ENN Team Dedication to Mr Abdikarim Hashi Kadiye Shared by Leo Matunga, Nutrition Cluster Coordinator, Somalia We extend condolences to the family and friends of Mr Abdikarim Hashi Kadiye and Mr Duale, who died on the 12th of January 2011 in Somalia. Mr Kadiye the head of Tofiiq Umbrella Development organisations (TUOS) and also, the nutrition cluster focal point for Hiran and Galgaduud, had just recently organised and chaired the Hiran- Galgaduud cluster meeting on the 10th of January 2011. Mr Kadiye was killed together with his driver, Mr Duale, in an ambush by unknown gunmen between Dhusamareb and El Dhere. This is a senseless loss of life and a huge loss to the work of the cluster in the region. Mr Kadiye had been the nutrition focal person for Galgaduud for almost a year now, was a hard working member of the cluster, and had tried under difficult conditions to continue to organise partners meetings in the area and ensure smooth operations of the nutrition programme. We extend our heartfelt condolences to Mr Kadiye and Mr Duale’s families, friends and the TUOS staff. Leo Matunga and the ENN Team 68
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January 2012 Issue 42 ISSN 1743-508
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Moving on, an article by Bernardett
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Field Article not adequate for dete
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Qualitative review of an alternativ
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Research of questions and a scoring
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Research of the crisis still caught
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Research provided 175-200 kcal/kg/d
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