CHIWAMBA, Malawi, 21 October 2008 - Anna Jumbe did not understand why her 14-month-old baby was always sick. Disillusioned with treatments she had administered, none of which worked, she decided to walk 10 km to Chiwamba Health Centre, where her baby Brenda was diagnosed with acute malnutrition and admitted into the Nutrition Rehabilitation Programme.
"I have been here for seven weeks," she said. "My baby is able to eat and play. She is now okay and thriving."
Brenda, now two and half years old, had lived with chronic malnutrition for more than a year before she was brought for treatment. Thankfully, she is on her way to recovery. But as the health centre's Medical Assistant Lackson Mbowela observes, preventing malnutrition has to begin in homes and communities.
"The major causes of malnutrition - apart from inadequate food in the home - are poor food preparation, ignorance on proper infant feeding practices, and traditional practices which forbid children from eating certain types of foods, such as eggs," said Mr. Mbowela.
Health Surveillance Assistants
This is where Health Surveillance Assistants, or HSAs, come in. They are a cadre of trained, salaried outreach workers who serve as foot soldiers in the frontline battle against largely preventable childhood diseases in Malawi. So far, the government has trained 11,000 HSAs.
Forty-one HSAs based at the Chiwamba centre reach a population of 63,000 in the surrounding area. They visit villages twice a month, armed checklists asking mothers if they have enough ready-to-use therapeutic food (RUTF) for their young children. The mothers are also counselled on breastfeeding and other ways to provide the food a baby needs to thrive.
The Chiwamba nutrition programme is part of a larger effort comprising around 200 health centres that provide 'community therapeutic care', in which malnourished children are treated at home with RUTF. The participating centres are located in 21 of Malawi's 28 districts, and UNICEF recently advanced funds for six more districts to introduce the programme.
Household food security
UNICEF funding supports the training of health workers in management of malnutrition, dissemination of treatment guidelines, monitoring, supervision and data management.
The 200 centres are currently reaching about 40,000 malnourished children a year. Once the programme is increased to 27 districts, it will reach about 50,000 children.
"My work is to know their health," said HSA Madalitso Chadewa. "How they live, do they have enough food? If they do, I counsel them to keep it up. If not, I tell them what is needed and try and find out if they can afford it."
In Malawi, as in most other countries that depend on rain-fed agriculture, household food security is largely subject to seasonal harvest. Ms. Jumbe's husband, Samson Chadza, noted that the period from February to March is peak hunger season; during those months, most granaries are empty as people await the next harvest in May.
Vegetables for selling and eating
"This season, we harvested 20 bags of maize," he said. "We also have a garden where we have planted vegetable for eating and selling."
Mr. Chadza's harvest is an unusually good one, thanks to a fertilizer and seed subsidy programme initiated by the government in 2005. He plans to sell some of the maize and invest in rearing chickens.
The task for Mr. Chadewa, the HSA, is to ensure that Mr. Chadza follows through with his plans for the sake of little Brenda.