Malnutrition in Uganda

Malnutrition may be considered in 2 ways. Firstly malnutrition is a diet deficient in calories. Calories come from fats, proteins, carbohydrates and micro nutrients, in this way the dietary intake does not match the calories used. The other way to consider malnutrition is as a dietary lack of micro nutrients. 

Wikipedia further explains:

Extreme undernourishment, known as starvation, may have symptoms that include: a short height, thin body, very poor energy levels, and swollen legs and abdomen. People also often get infections and are frequently cold. The symptoms of micronutrient deficiencies depend on the micronutrient that is lacking.

Malnutrition can often be caused by a lack of high quality food. It can also be related to high food prices and poverty. Lack of breast feeding and infectious diseases like gastroenteritis, pneumonia, malaria and measles may also contribute to malnutrition. Wikipedia continues:

There are two main types of undernutrition: protein-energy malnutrition and dietary deficiencies. Protein-energy malnutrition has two severe forms: marasmus (a lack of protein and calories) and kwashiorkor (a lack of just protein). Common micronutrient deficiencies include: a lack of iron, iodine, and vitamin A. During pregnancy, due to the body's increased need, deficiencies may become more common. In some developing countries, overnutrition in the form of obesity is beginning to present within the same communities as undernutrition.

Malnutrition affects the whole body. The following are some of the effects of malnutrition identified by Wikipedia:

Site	Sign
Face	Moon face (kwashiorkor), simian facies (marasmus)
Eye	Dry eyes, pale conjunctiva, Bitot's spots (vitamin A), periorbital edema
Mouth	Angular stomatitis, cheilitis, glossitis, spongy bleeding gums (vitamin C), parotid enlargement
Teeth	Enamel mottling, delayed eruption
Hair	Dull, sparse, brittle hair, hypopigmentation, flag sign (alternating bands of light and normal color), broomstick eyelashes, alopecia
Skin	Loose and wrinkled (marasmus), shiny and edematous (kwashiorkor), dry, follicular hyperkeratosis, patchy hyper- and hypopigmentation, erosions, poor wound healing
Nail	Koilonychia, thin and soft nail plates, fissures or ridges
Musculature	Muscles wasting, particularly in the buttocks and thighs
Skeletal	Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies
Abdomen	Distended - hepatomegaly with fatty liver, ascites may be present
Cardiovascular	Bradycardia, hypotension, reduced cardiac output, small vessel vasculopathy
Neurologic	Global development delay, loss of knee and ankle reflexes, poor memory
Hematological	Pallor, petechiae, bleeding diathesis
Behavior	Lethargic, apathetic

The Global Nutrition Report, From Promise to Impact: Ending Malnutrition by 2030 provides the following information about malnutrition in Uganda:

64% of children from 6-59 months are neither stunted nor wasted.

For children under 5 years:
52% of mothers are under 18 and 32% of mothers 18 or over, at the time of birth have stunted children.
2% of males and 3% of female children are over weight.

In the general population there is:
4.3% wasting prevalence.
26.7% of women of reproductive age have anemia.
63.2% of women exclusively breast feed.
20% of urban children and 35% of rural children are stunted.
34.2% stunting prevalence.

Malnutrition is still a big problem

The USAID Uganda Nutrition Profile provides the following information. In 2012 the population of Uganda was 33.6 million and the population under 5 years of age was 6.5 million. Based on 2011 figures the following prevalences were found:

Stunting among children under 5 (0-59 months) 33%
Underweight among children under 5 (0-59 months) 14%
Wasting among children under 5 (0-59 months) 5%
Anemia among children aged 6-59 months 50%
Anemia among women of reproductive age (15-49 years) 24%
Thinness among women of reproductive age (15-49 years) 12%
Children aged 0-5 months exclusively breastfed 63%
Breastfed children aged 6-23 months receiving a minimum acceptable diet 6%

Applying the percentages to the Number of Persons With Disabilities (PWDs) in Uganda estimated at 5,625,000 in 2014: 4.3% or 241,875 PWDs have some kind of wasting and 34.2% or 1,912,500 have some kind of stunting.

This article Uganda: Malnutrition Is Still a Leading Cause of Illness from 2015 sums up the issues described in this blog:

Maimuna Katooko sits on a mat at her veranda, all her attention turned to her son whom she is holding on her lap.
The child, who is seated motionless, looks emaciated; with pale and wrinkled skin, sunken eyes and scanty hair that bears a golden brown hue.
The six-year-old boy now looks like a two-year-old and has a stiff gait, protruding belly and rusty-coloured hair that shows you all is not well.
Katooko, who hails from Hangaraba village in Himutu sub-county in Butaleja district, is one of the many mothers whose children suffer from severe malnutrition.
Her son looks wasted and when he cries, his voice is faint.
"He is so sick; when I last weighed him, he was about six kilogrammes and at times we feel he is going to die anytime. I have little hope that he will survive," Katooko says.
When Daily Monitor arrives at this home, Katooko looks exhausted and Mudaha her fifth child crawls into her lap.
"I have taken Mudaha to all the health clinics, but he still looks like this," she says in despair. "I don't know what to do anymore."
The family only eats once a day. Katooko and then children have a meal of rice or millet bread and greens at about 3pm.
Dr John Matovu, the District Health Officer says local reports indicate that most families resort to foraging for anything edible such as roots, leaves and wild rats to supplement porridge during the dry seasons
Burdened with countless household chores, including cooking, fetching water and firewood, and foraging for extra food, mothers such as Katooko find it difficult to attend properly to the needs of sick children. She has six children; all aged less than 12 years.
"And this explains why one out of every four families in Butaleja have a child who is malnourished. Mudaha represents one out of every three children in Uganda who are stunted," says Dr Matovu...
Brenda Namugumya, Senior Technical Officer-Nutrition from Food and Nutrition Technical Assistance (FANTA II) project says although households have made strides in overcoming under nutrition by having kitchen gardens, it still remains a multi-sectoral challenge.
She revealed that as food shortages start to affect parts of Uganda, it is the youngest who suffer most.
Namugumya says research has shown that 12 per cent of women in reproductive age are too thin (BMI of less than 18.5 kg/m2), 23 per cent women of reproductive age have anaemia (less than 12.0g/dl) and that three in ten pregnant women have anaemia that impacts on the 438 maternal deaths per 100,000 live births.
Dr Elizabeth Madraa, the Fortification/Policy Advisor at Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Uganda says malnutrition affects children under the age of five in whom growth is fast and beyond which age, some of the nutrition interventions cannot work.Case for fortified food supplements
Dr Madraa says without the food and nutrients many children's condition will not improve and that our local health facilities should be empowered to start the therapeutic feeding programme for children who are malnourished to receive special nutrition supplies.
She says fortified foods are crucial in addressing the problem of malnutrition, which remains a big burden in Uganda and urged the government to assist middle and small scale farmers to fortify their products.
Dr Madraa explains that while fortification is one of the most cost effective and sustainable approaches to addressing micronutrient malnutrition, it should be implemented alongside other strategies including bio-fortification and supplementation.
"Consumption of fortified foods is meant to improve nutritional status and to decrease the degree of malnutrition and prevent micronutrient deficiencies," says Dr Madraa.
The Cost of Hunger Report 2013 released by World Food Programme and National Planning Authority indicates that 47 per cent of child deaths in the country are associated with malnutrition.
According to Boaz Musiimenta, head of nutrition department in the Prime Minister's office, available statistics indicate that 45 per cent of children in Karamoja are affected by malnutrition while in the western region it stands at 44 per cent.
Musiimenta says that the community needs to be enlightened on food security in their homes if the problem is to be reduced countrywide.
"It is not that people lack food but they are ignorant of the right food combinations," says Musiimenta.
Health is not made at the hospital, it begins at home. During home visits in Ishaka District, we encountered a family with an old woman in her 80's and nine children; three of whom were below five years and whose parents were not home. At about 1pm, there was no sign of food being prepared because the family members had just left the garden. The children's mother had taken one of the twins (the youngest) to hospital.
The village health team member, Agaba Jacinta, recalled an earlier visit when they discovered the nine-month-old twin babies who could not sit, indicating that the were malnourished.
"Parents work so hard in the gardens and do not find time to feed their children. For breakfast, they only eat cold food they prepare in the evening," says Agaba. This is the major cause of malnutrition here," reveals the village health team member...
According to Dr Lynneth Turyagyenda, a nutritionist at the Mwanamugimu Nutrition Unit in Mulago hospital, there is a peak season when the unit receives more malnourished children than usual and this applies to children from both rich and poor families.
"The rainy season is our peak season. We receive an average of 30 children monthly but when it rains, the number increases to 50 yet we only have 30 beds at the unit. Since they come with severe malnutrition, we cannot send them away, so they sleep on the floor," says Dr Turyagyenda.
Use of fortified foods in cases of severe malnutrition: According to Dr Mansur Toko, a nutritionist at Jinja Regional Referral Hospital says, it has been hard to treat malnourished children due to the community misconception where people refer to the condition as the disease of the lake or witchcraft.
Owing to this, he says, "There is poor health-seeking behaviour among the people and the situation is worsened by lack of family planning where mothers do not get enough time to care for one child because they get pregnant again.
Dr Elizabeth Madraa, a fortification and policy advisor SPRING Uganda notes that with the new government policy to fortify staple foods in the country, the use of Ready to Use Therapeutic Foods (RUTFs) is the way to curb severe and acute malnutrition in Uganda.
Food fortification would according to Dr Madraa help prevent and control diseases caused by micro-nutrient deficiencies. All fortified foods have an F logo on their packages and they include wheat and maize flour, cooking oils and fats with Vitamins A, B1, B2, B6, B12, iron, zinc, folic acid, zinc minerals.
Signs of malnutrition: Malnourished children usually lose muscles and their body fat wastes away. They will also get hair loss and darkened skin tone, become apathetic, lying without moving or crying for long periods of time.
The child may develop a swollen stomach, brittle hair. A child with kwashiorkor may seem healthy due to excess water accumulation in the body and will have a round, full look. The child will also be apathetic and tired.
Improper care and feeding for both expectant and lactating mothers also affects their nutrition status as well as that of the baby.
"A malnourished mother will give birth to a malnourished and low birth weight baby and if no intervention is made to educate the mother on how to feed, the problem can never be solved," says Lynneth Turyagyenda a nutritionist and public health specialist at Mwanamugimu Nutritional unit in Mulago hospital.
She further remarks that mothers should breastfeed their babies exclusively for six months and continue breast feeding them until they turn two years with appropriate complementary feeding.
Brenda Namugumya, a nutritionist at Food and Nutrition Technical Assistance (FANTA) notes that most people in the villages have enough space to grow the crops on which they should be feeding to curb the problem but they sell all their produce and end up starving. This is the major cause of malnutrition in rural areas.

Mission 2014 Feeding the World notes the 50% of the malnourished come from low income farm households. They also note that children under 5, the micro nutrient deficient and people with HIV/AIDS and other disabilities are all vulnerable to malnutrition.

In summary, 241,875 PWDs having some kind of wasting and 1,912,500 having stunted growth it is clear that the issue of malnutrition is of great importance. PWDs face many challenges, the evidence above shows they are additional vulnerable to the burden of malnutrition. The malnutrition of PWDs, their children and families requires urgent attention.

For more information about strategies to combat malnutrition see Strengthening Partnerships, Results and Innovations in Nutrition Globally (SPRING) and United States Agency for International Development (USAID) Uganda.