by Farai Mutsaka
Harare, Zimbabwe – Sitting on her mother’s lap, 10-month-old Tanaka fidgeted and shrugged off attempts by the nutritionist to feed her another serving of therapeutic food at Edith Opperman Maternity Hospital in Zimbabwe’s capital, Harare.
“She clearly has had enough for now,” said the nutritionist, Ivy Muchenje, to the baby’s mother.
“You can give her some more when you get home,” she added, before handing the mother the unfinished sachet and 6 more to last the week, as well as instructions on how best to feed the baby.
Tanaka is one those benefitting from UNICEF Zimbabwe’s support for life-saving and preventative treatment to over 650,000 children and women who are at risk of malnutrition. With assistance from the UN Central Emergency Response Fund (CERF and UK Aid, the programme is supplying therapeutic food-RUTF), micro-nutrients and vitamin A supplementation.
This is one of several interventions by UNICEF Zimbabwe that include incentivising health workers to continue reporting for duty and helping them to screen children for malnutrition, as well as provide education to mothers on nutrition-related issues.
The interventions have become life-saving in Zimbabwe, where children are one of the populations most affected by food insecurity and other care practices negatively impacted by the region’s worst drought in decades and deepening economic problems. Severely malnourished children are at a high risk of death and timely interventions are critical to save their lives.
Nearly 1 in 3 children under five are suffering from malnutrition, while 93 per cent of children between 6 months and 2 years of age are not consuming the minimum acceptable diet and cases of Pellagra, a deadly disease linked to micro-nutrient deficiencies are also on the increase.
Mothers whose children are benefitting from the intervention say they are hopeful of their children’s future again.
“Plumpy nut (therapeutic food) is helping a lot with her appetite. Her weight was very low but she has been gaining a lot since the nurses asked us to give her plumpy nut,” said Tanaka s’s mother, Rutendo, stuffing the sachets in her handbag.
At 5 months old, Tanaka weighed 6kgs before being put on the supplements programme, she said.
“Now she is picking up bit by bit, at 10 months she is at 7.7 kgs but the nurses said the target is 8.1kgs. I think we will achieve it,” she added.
The hospital was a hive of activity. About a dozen women holding their babies sat on a bench in a crowded corridor waiting for their turn for Prevention of mother-to-child transmission of HIV services. Across, in the maternity block, pregnant women trooped in holding bags with baby clothes.
The hospital attends to more than 250 children a day for growth monitoring, immunisation and assessing malnourishment, said Phyllis Bangano, the nurse-in-charge.
All this would not have been possible only a few weeks ago. In early November last year, the hospital, located in the city’s populous and oldest suburb of Mbare, shut its doors to patients after nurses claimed they could not afford to report to work due to economic challenges.
Council-run health facilities are a key pillar of the health system of the city, which has a population of at least 2 million people, according to government figures.
Mothers with children in dire need of services such as the nutrition programme were left stranded after the closure of council health facilities at a time when doctors at government hospitals were also on strike.
For pregnant women, giving birth came with grave risks as the previously unthinkable home births by untrained midwives became the next available option.
With the salary dispute continuing, UNICEF Zimbabwe stepped in to provide transport incentives for the nurses to return to work in December.
The intervention resulted in the therapeutic feeding programme getting back on track. The programme is being rolled out in other council health facilities as demand increases due to the twin problem of drought and a deteriorating economy.
Screening critical to picking up malnutrition
At Rutsanana Polyclinic in Glen Norah suburb in Harare, a screening process during regular baby growth monitoring check-ups supported by UNICEF is assisting nurses identify children suffering from malnutrition.
On a recent day, mothers and their babies waited in line on a wooden bench in the tiny weighing room. Some chatted excitedly about their babies and chuckled each time loud cries emerged from the nearby maternity ward. Charts on nutrition and posters on waterborne diseases hung on the walls and mothers were encouraged to read and write the information down.
Two nurses screened children for malnutrition. One child was put into a weighing bag and one of the nurses measured his height. The other nurse took over at the salter scale. After noting the measurements, the nurses looked at each other, and then at the mother while shaking their heads – clearly concerned for the child’s welbeing.
“We have to put him into the IMAM (Integrated management of acute malnutrition) programme right away,” said nurse-in-charge Sibongile Muzira.
The infant, 4-month-old Anesu, was born underweight at 2.2 kgs.
“It would have been alright if the mother had enough breastmilk to feed the baby,” said Muzira. “But because of the economic situation in Zimbabwe, the mother is not getting enough food to produce enough milk. The baby is now 4 months old at 4 kg. That is severely underweight for a child that age. Ideally, the baby should be above 5kg,” she said.
The baby’s parents talked of a dire food situation back at home.
“Food is a big problem, there are no jobs and money is just difficult to come by,” said Tinashe, sitting next to his wife in a room where the nurses were counselling them on nutrition issues. The father of three said he is unemployed and makes about US$30 a month doing part time jobs such as brick moulding.
The family usually has two meals a day: sadza (thick maize porridge) and vegetables in the morning and evening. Ingredients such as tomatoes, onions and adequate cooking oil are a luxury, said his wife Marita. “We sacrifice on some food items to pay school fees for the other two children,” she said.
“They are only getting carbohydrates and maybe a bit of Vitamin A. They can’t afford a balanced diet,” said Muzira, the nurse-in-charge.
As the problem spirals amid signs of food and economic problems further deteriorating during this lean agricultural season, more support is needed, said Mathieu Joyeux, the UNICEF Zimbabwe Nutrition Manager.
The encouraging situation at Edith Opperman Maternity Hospital shows how more support can help save lives, he said.
“Very soon we will be launching a humanitarian appeal as the U.N to call for more resources. In this situation where there is high inflation we need to get the nurses back at work, the doctors back at work, the volunteers doing their work and the children receiving the food and care they need. This costs money,” said Joyeux.
Despite the need for more support, nurses at the hospital said they are grateful that the situation has significantly improved due to the intervention by UNICEF Zimbabwe.
“We are almost there. In December we had 445 (maternity) deliveries, we have 71 so far in January. That’s about our normal trend. The supplementary feeding programme is on full throttle,” said Bangano, the nurse-in-charge.
But none is happier about the UNICEF Zimbabwe intervention than Tanaka’s mother, who once worried about her now healthier looking baby.
“Imagine if the hospital was still closed and Tanaka not able to get this help… I am so relieved,” she said.