Malnutrition costs Uganda Shs 1.8 trillion in 4 years

In four years since 2009, government has spent an estimated Shs 1.8 trillion on stopping and treating malnutrition, a new report by Save the Children International’s Child Rights Governance Initiative (CRGI) reveals. 

The report titled, ‘Budget transparency and Child Nutrition’ says it costs the country about $120 (Shs 300,000) on average to treat a malnourished person and the opportunistic infections. This is equivalent to 5.6 per cent of the country’s gross domestic product.

According the 2011 Uganda Demographic Health Survey (UDHS), an estimated 2.4 million children (about 33 per cent) aged less than five are stunted and about 110,220 children have died in the last five years due to malnutrition.

“Uganda could save Shs 266bn if the prevalence of stunted children is reduced to 10 per cent. Unfortunately, adequate nutrition is seldom treated and prioritized as a human right and there are flaws in accountability and transparency,” said Peterson Kato Kikomeko, a senior lecturer at Kyambogo University, during the recent launch of the report.

The report also revealed that access to budget information about the government’s child nutrition interventions was limited at national level and almost non-existent at sub-national level.

Photo/Courtesy

By far, Karamoja, West Nile and the southern western region have the highest number of stunted and wasted (low weight for height) children.

Being stunted has long-term effects on children including loss of cognition, low self-esteem, societal marginalization and poor performance at school as their brains do not reach their full potential.

Boaz Musiimenta, a senior policy analyst in the prime minister’s office says malnutrition is also associated with almost a quarter of all maternal deaths, despite it being preventable.

“Such preventable deaths reduce Uganda’s gross domestic product by an estimated 4.1per cent, costing US$ 310 million in lost economic productivity every year,” he said.

“Most mothers simply boil bananas add salt and a meal is fixed and instead of giving children a balanced diet, many people, especially in rural areas focus on quantity.”

To curb malnutrition in the country, Musiimenta advocates both direct and indirect interventions. Direct interventions include: food supplements, micronutrients powders and fortification of the food that the children eat whereas indirect interventions include: de-worming, safe drinking water and malaria control among others.

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Civil society organizations under their umbrella association; the Uganda Civil Society Coalition on Scaling up Nutrition (UCCO-SUN) urged government to provide detailed and robust information about child nutrition interventions, both at national and sub national levels.

“Regular information should be provided throughout all phases of the budget process and at all levels of government and information on planned child nutrition spending over the multiple budget years should be released,” reads a UCCO-SUN statement released during the launch of the child nutrition report.

It adds that timely annual accounts must be submitted to independent audit offices to allow for timely release of audit reports. Independent audit institutions should also be made available for public scrutiny after completion.

The new report focuses on investment in children aiming to ensure that all children, especially the most marginalised, benefit from greater public investments and better use of society’s resources in realising children’s rights.

It was launched under the theme, “Recommitting to scaling up nutrition: the need for effective accountability and transparency” in Kampala.

Starving for attention; kids under five wasting away

BY RACHEAL NINSIIMA

For the first time in my life, I saw a severe acute malnourished child. I will never forget his appearance. I met this toddler at Bubukwanga Health Centre III in Bundibugyo District where I had gone to report on the Congolese refugees’ influx.

He was one and half years old. His face was swollen, lips chapped, legs highlighted with open sores and was severely lethargic. He rested comfortably in his father’s bosom as if clinging onto him for life support. His little feet hang midway between his father’s calf and the floor and I noticed that they too were swollen, a visible sign of oedema. Oedema is severe wasting of the body swelling from excessive accumulation of watery fluid in cells, tissues or cavities. 

Father and son at Bubukwanga Health Centre III where the toddler was being treated for malaria. He is also acutely malnourished

“My son occasionally gets sick and a year after he was born, we tested him for HIV and found out that he had it,” he told me.

The two had spent five days in the health facility where his son had been admitted with severe malaria. When I met him, he told me that they have only one meal a day and the situation is not different at home where there are four more children.

In this region of Uganda, families mainly grow cocoa, a cash crop and live off its sale as a means of living. Majority of the households survive on less than $2 (Shs 5000) per day and are battling with malnutrition. In a report released early this year titled, ‘Food Security Eludes Households in the Ruwenzori region’ indicates that over 650 children in Bundibugyo are stunted (low height for age). Stunting is associated with higher mortality and lower cognitive development

This trend is however consistent throughout the country especially in rural areas where poverty is rife. According the 2011, Uganda Demographic Health Survey (UDHS), an estimated 2.4 million children (about 33 percent) aged less than five are stunted and about 110,220 children have died in the last five years due to malnutrition.

 By far, Karamoja, West Nile and the southern western region are leading with the highest stunted and wasted (low weight for height) children.

 The situation is worse for those afflicted with HIV.

“Children living with HIV are five times more likely to die from malnutrition before their second birth day compared to non infected children and worse, stunting is irreversible after 24 months of age,” Michele Sibide, the Executive Director of UNAIDS said.

This was during the international conference on maternal, newborn and child health in Africa that was held in South Africa between 1^st and 3^rd August.

In Uganda, more than 40% of the acutely malnourished children are HIV positive.

In fact Uganda loses 1.8 trillion shillings every year to averting malnutrition and treating its opportunistic infections according to a study, ‘Cost of Hunger’ conducted by the office of the prime minister this year. It costs the country about $120 (Shs 300,000) to treat a person affected with malnutrition and its opportunistic infections.

“Most health interventions in the country are done by development partners and yet Uganda needs only 15b from government to intervene in nutrition programs,” Florence Mutyabule, the chairperson of the Uganda Parliamentary forum for children said in an interview.

She added that consumption of mostly staple foods without a good balance of vege­tables, fruit, beans, and animal-source foods can lead to nutrient deficiencies and poor growth in children. 

Many Ugandan children like these are dying before their fifth birthday because of malnutrition

Situation across the continent;

Despite global progress in the fight against hunger and under nutrition, 165 million children globally were stunted as of 2011. This, according to report from the African Union on nutrition, new born and child health was as a result of inadequate vitamin and minerals in their food. In eastern Africa 42% under fiver five were affected as of 2011.  

In Zambia, 45% of children are stunted.

Ethiopia has over the past two years reduced acute malnutrition from 13.4% to 9.5% especially in the southern Tigre and northern Shao regions. This follows a partnership to end famine between the Ethiopian government and Food and Agricultural Organization (FAO) which supported women with agricultural income generating activities such as poultry farming and vegetable growing.

Ghana and Mauritania have also reduced hunger by 50% since 2001 thus reducing incidences of malnutrition.

In Uganda, Vitamin A deficiency has doubled among children under five over the last 10 years between 2001 and 2011 from 19% to 38%. This is according to the 2011 UDHS.

With the growing impetus to end under and malnutrition, Hon. Sarah Opendi, the state minister for primary health care advises mothers to exclusively breastfeed their children.

“A non breastfed child is 14 times more likely to die of malnutrition and related illnesses such as anaemia in the first six months of life than an exclusively breastfed child,” Hon Opendi said in an interview.  

Using therapeutic foods as drugs;

At the government run hospital of Bundibugyo, RECO industries ltd is providing malnourished children with ready to use therapeutic foods commonly known as RUFTs. RUFTs are high energy foods fortified with macro and micro nutrients such as vitamins and minerals. It is a combination of locally grown foods such as maize, rice, cassava.

While one of the most renowned international nutritional products for malnourished children is Plumpy Nut for children and Plumpy Sup for adults, these are not always available.

Reco Industries together with United Nations Children’s Fund (UNICEF) is currently using RUFTs to treat 20,000 children against severe acute malnutrition. Since the beginning of the year, they have reached over 17,000 children and adults in 103 health facilities across the 62 districts with RUFTs.  

“Our target is to integrate nutrition in agriculture and livelihood and our aim is to train 150,000 small holder farmers on what crops to plant, post harvest handling among others,” Brian Rwabogo, Reco Industries’ chief of party said. This was during the recent launch of the production for improved nutrition project that is working to provide therapeutic and supplementary foods to treat malnutrition.  The project is funded by the United States Agency for International Development (USAID) and is being implemented by RECO industries.

RUFTs are now on the World Health Organization (WHO) essential drug list.

However, challenges still remain. Agnes Baku Chandia, the head, nutrition unit in the health ministry says most foods used are prone to afflatoxins (naturally occurring poison) produced by a fungus. There are also inadequate storage facilities and limited community involvement in adopting and distributing this product country wide.

To avert these challenges, there is need for wide spread awareness.

“As leaders, we owe our communities knowledge. To educate them that they need to cultivate food because therapeutic is a drug and not everyday food,” Hon Janet Museveni, minister for Karamoja affairs said during the launch. 

Hon Janet Museveni signs the production for improved nutrition paper during the program launch last week

Momentum builds country-wide to end malnutrition

In April this year, the Uganda Action for nutrition (UGAN) launched a tow year campaign dubbed, ‘Commit to scale up nutrition, Food for all.’ Its aim is to increase awareness of the importance and how to achieve proper nutrition among schools across the country.

Earlier in 2011, the government adopted the Uganda Nutrition Action Plan (UNAP) as the framework for scaling up nutrition in Uganda between2011–2016.

The goal of this plan is to improve the nutrition status of all Ugandans, with emphasis on women of reproductive age, young children, and infants. The plan is intended to reduce the magnitude of malnutrition in Uganda and its impact on the individual, the household, the community, and the nation at large.

“The strategic challenge at hand calls for increased financial and human resource investment in all relevant sectors for nutrition and food security; adequate institutional structures to scale up nutrition, reporting and supervision,” Hon Amama Mbabazi, Uganda’s prime minister said during the launch of the cost of hunger report on June 18 at Imperial Royale Hotel.

He also called for wide social movement to rally support for nutrition services among the public and stakeholders a robust monitoring and evaluation framework, and an enabling legal and policy framework for nutrition and strengthened coordination among stakeholders.

With Africa’s population projected to reach 2 billion by 2050, the unprecedented challenge of feeding the continent’s children looms large. Nutrition interventions are among the best investments that African countries can undertake.