The long battle to heal a child of marasmus

        After several months trying but in vain to make her first-born child gain weight, Husna Juma, a school teacher in Mkuranga District, Pwani Region eventually turned to social media in search for answers. Today, she regrets her past decisions. “Each time I took her for routine clinics, I was scolded by nurses. They said I wasn’t feeding my daughter properly. But they didn’t tell me how to do it. What would I do?’’ she says.

As Husna narrates the struggle with her daughter’s body weight problem, she is at the malnutrition ward of the Muhimbili National Hospital (MNH). Her daughter, Mariam* aged 1 and half years, has been admitted in this hospital for over a month due to diarrhoea and marasmus—a form of malnutrition characterized by inadequate energy intake in all forms, including protein.

Husna speaks to Your Health on the day her child would be discharged from hospital.

“…for all the days I have been here, I have learnt lessons. At first, I didn’t know that not feeding a child properly could lead to hospital

admission,’’ she concedes.

Her child is not the only one being discharged that day, says the nurse in charge of the malnutrition ward at MNH, Ms Grace Mcharo.

“Four children who have been on rehabilitation here due to marasmus and others with kwashiorkor, are getting discharged too,’’ she tells Your Health.

But, most of them—over 20—who were admitted due to malnutrition at the Makuti A and Makuti B wards of MNH, remain behind.

One of those remaining is a 9 month old baby of Rebecca Zakaria, 25.

“He was found with a heart problem but doctors say he has also developed malnutrition. I didn’t know how to deal with her,’’ says Rebecca.

“I have been getting lessons on how I should take care of his nutrition needs. So, I will still be here for more several days, I guess,’’ she says.

Stories of women taking care of malnourished children do not very so much.

During interviews, Your Health finds out that they have one thing in common—lack of the right information on feeding.

But also, child malnutrition remains a countrywide problem. Most children are stunted because of poor feeding, according to United Nations International Children’s Emergency Fund (Unicef).

Stunting currently affects 42 percent children under the age of five and is only a two percentage points lower than it was five years ago, says Unicef.

However, apart from stunting, malnutrition could have dire consequences on a child’s health—including leading to death.

“When malnourished children fall sick with diarrhea, malaria or pneumonia they are more likely to die. These deaths can be prevented if nutrition is improved,’’ says Ms Mcharo.

“When we admit them here, we feed them on special milk formulas—F75 and F100 for rehabilitation,” says Ms Mcharo.

“They are severely malnourished and cannot tolerate normal amounts of protein and sodium or high amounts of fat. We feed them on that special formula milk,” says the nurse, also a nutrition expert.

“There are children who have ended up here because they have other underlying health problems, such as HIV/Aids or heart diseases. In such cases, malnutrition comes in as a complication,” she adds.

“…but most mothers or care takers with malnourished children do not often realize that their children could have such a problem until it’s diagnosed at a hospital,’’ explains Ms Mcharo.

The story of Husna’s baby

When her baby was eight months old, Husna says. “I began noticing that she had an old-looking face. She was getting thinner and thinner. But one thing I liked about her is that she was always eager to eat. I didn’t think it was a big problem.”

“But then, she developed diarrhoea. I began losing hope that she would never fully grow. I have always wanted to see my child grow and attend school like other children. I felt like this was not forthcoming. May be I was wrong.”

“At one moment I got terrified because she was losing more weight. There is a day I cried a lot. I could see her wrinkled buttocks. She always looked tired, but what would my tears help?’’ she queries herself.

Tracing the root of the problem

Working as a teacher in Njopeka Primary School, over 30 kilometers from her home, Husna has always been challenged with how to take care of her child.

“Most times I had to leave the child with a maid. Because of the nature of my work, for almost the entire day I am at school, busy teaching.”

“I used to have a lot of trust in the maid but one day I discovered that she hadn’t fed the baby as I had instructed her. She lied to me.”

“The food had actually been dumped in the dustbin. May be she had been doing this all along. Who knows?

“That incident taught me lessons. That’s when I realized that my child wasn’t getting enough food.”

“At one moment, I stopped taking my child to the clinic because the nurses would keep telling me that I am not serious with my child’s diet.”

On child’s growth card, my baby’s pattern was had already changed from green to grey. That indicates poor weight gain. It was getting to red, the worst one.”

Husna turns to social media

“One day, I figured out that internet would help me solve my daughter’s weight problem. I found a Facebook page where a certain food recipe for a baby like her was being explained,’’ she says.

“I learnt how to make a certain kind of porridge—a mixture of maize flour, millet, potatoes and cassava flour. Since then, that’s what I was feeding my daughter,” she says but shying away.

When asked why she feels shy, Husna reveals, “In fact, I just learnt recently that I wasn’t feeding my daughter rightly.”

“For the days my daughter has been admitted here at Muhimbili, I have learnt that what I was feeding on my daughter was purely carbohydrates. No proteins at all.”

She regrets

“When I look back,” she says, “I regret.” I shouldn’t have been here at the hospital. It’s just because I didn’t know what to do.”

The nurse in charge, Ms Mcharo, says there is need for more sensitization on proper nutrition among women in urban and rural areas.

“You can see that Husna’s problem was not that she doesn’t have what to feed her child. She could have afforded to give the child any kind of food but the problem was on what and how to feed the child.”

“When she was mixing maize flour, millet, potatoes and cassava flour to get what to feed her baby, she was not actually providing the right food. She was actually giving all carbohydrates.”

“We usually advise mothers according to what they have. In the case of Husna, she should have thought of making maize flour porridge—mixing with milk or groundnuts.”

“If she doesn’t have this, she can mix millet with groundnuts, or even eggs. It’s important to know the ingredients in these foods.

A medical Officer in Dar es Salaam, Dr Renick Kihongo says, “I have seen a number of women who refuse to take their children for routine clinics because they feel embarrassed that their children are growing poorly. This attitude also may come from the fact that they have not been advised well.”

“It’s important for them to get the right information regarding what and how they feed the children,’’ says Dr Kihongo.