Breaking the Cycle of Malnutrition

“My name is Shirley Yang. I am a CFHI intern, working virtually with CFHI’s Ugandan partner organization, KIHEFO. In this op-ed, I explain the importance of nutrition education in breaking the cycle of malnutrition and clarify misconceptions about causes and effects of malnutrition. After providing a brief overview of active nutrition programmes, run by both the Government of Uganda and international humanitarian organizations, I offer suggestions about how to improve the system based off of my own research and meetings with my supervisor, Dr. Geoffrey Anguyo. “

The role of nutrition education in promoting healthy diets cannot be underestimated. Malnutrition is not characterized solely by lack of food, but also lack of knowledge of available food. Malnutrition, especially in childhood and pregnancy, can have detrimental consequences on one’s long-term well being. The negative effects are not confined to an individual; they will eventually seep into the community and country, affecting human capital availability, economic productivity, and national development. 

In recent years, Uganda has made strides in reducing poverty levels and undernutrition rates. However, malnourishment continues to threaten the Ugandan population as half of children under five and one quarter of child-bearing age women are anemic. To add on, more than one third of all young children suffer from stunting, a consequence of inadequate nutrition and care. There are many factors that drive malnutrition in Uganda, including early motherhood, lack of family planning, lack of access to clean water and sanitation, child diarrhea and malaria, and poor infant and young child feeding practices. 

To break the cycle of malnutrition, organizations are focusing on addressing the nutrition needs of the young child from conception through about 24 months and ensuring the nutritional well-being of the mother before she becomes pregnant. There are numerous movements, initiatives, and campaigns sponsored by the Government of Uganda as well as international humanitarian organizations addressing malnutrition in Uganda, such as the Scaling Up Nutrition (SUN) Movement, Comprehensive Africa Agriculture Development Programme (CAADP) Compact, and Preventing Child and Maternal Deaths: A Promised Renewed. 

As outlined in the Uganda Nutrition Action Plan (UNAP), the Government of Uganda is implementing a multi-faceted approach to eradicating malnutrition by addressing nutrition, agriculture, and food security simultaneously. UNAP focuses on improving maternal, infant, and child nutrition, increasing production of and community access to micronutrient-rich foods, and advocating for increased resources dedicated to nutrition intervention. 

Various USAID programs focusing on improving nutrition in Uganda are also utilizing a multi-faceted approach. For instance, HarvestPlus Meals for Nutrition in Uganda (MENU) focuses on increasing production and consumption of high-yielding iron-rich food such as beans and pearl millet. Such programs operate in rural areas as 84% of the population reside in rural areas and agriculture continues to be the main source of income for the majority of Ugandans.

Nutrition educational practices that directly involve the target audience, whether that be children, their caretakers, or pregnant women, have proven successful. For instance, a program promoting exclusive breastfeeding of infants that included peer counseling for mothers before and after giving birth resulted in increased rates of exclusive breastfeeding for children whose mothers received counselling compared to children whose mothers did not receive counselling. This sentiment is shared by my host organization KIHEFO. 

As shared by former KIHEFO interns through blog entries, “What’s on Your Plate” is an interactive hands-on activity built from KIHEFO’s Nutrition Guide. By inspiring participants, ranging from primary school students to caretakers, to diversify their diets by incorporating locally accessible foods that belong to the five different food categories quintessential for a balanced diet. Additionally, during our meeting this week, Dr. Geoffrey shared an instance in which a young child was severely malnourished and the KIHEFO nutrition center successfully rehabilitated the child using a vegetarian-diet. By telling this case, Dr. Geoffrey emphasized the importance of clarifying misconceptions; in this instance, he clarified that nutrition rehabilitation does not require meat, which most households only consume two to three times per year. This instance reinforced the importance of nutrition education — specifically, the importance of recognizing the importance of eating foods from different food groups to acquire sufficient macro- and micronutrients. 

The multi-sectoral strategy that the Government of Uganda and various humanitarian organizations are undertaking is very comprehensive. However, research has shown that postpartum counselling on breastfeeding is lacking. Although three-quarters of women delivered in a health facility in 2016, only 35% received postpartum counseling on breastfeeding. The disparity indicates that the health system is not taking full advantage of contact points to deliver high quality services. This trend could also extend to other health services provided by health professionals. 

During our meeting this week, Dr. Geoffrey continuously reinforced the importance of reaching out to churches, as the majority of Ugandans rely on spiritual leaders. Outreach is a critical component of ensuring the general public is properly educated on nutrition. Allocation of sufficient funds to outreach and communications is critical. Increasing points of communication, such as at churches and delivery centers, between health professionals and nutritional programme personnel with the general public is quintessential. By connecting with community hubs, nutrition education can be more readily available to the general public.


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