Uganda: Combating Malnutrition in Rural Communities

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Esther Wamono, a Nutrition Surveillance Officer, joined Action Against Hunger in the Karamoja region of northeastern Uganda in November. Determined to make a difference in her native country, Esther moved from the capital of Kampala, where she earned a master's degree in applied human nutrition, to one of the poorest and driest parts of the land-locked African nation to tackle high levels of malnutrition.

What are some of the common nutritional problems you encounter in the communities where you work in Karamoja? How is Action Against Hunger addressing them?

In Karamoja, a number of factors are causing high malnutrition rates. A principle one is poor hygiene and sanitation conditions. People who don't have access to latrines, hand-washing stations, and safe drinking water and other basic sanitation are much more likely to contract cholera, dysentery, diarrhea, hepatitis E, and other diseases that can also lead to malnutrition.

We're addressing this problem in a variety of ways: we're working with families to improve sanitation and hygiene in their homes, we're helping them construct and maintain household latrines, and we're digging bore holes to ensure they can access clean drinking water. People don't always realize how important clean water is in combating malnutrition, but it's critical.

Even if a child gets enough calories per day, he or she may not be getting enough of the proper nutrients. Children under five, pregnant and lactating mothers, and people living with HIV/AIDS are especially vulnerable to malnutrition. We're working with families in Karamoja to help diversify their diets through comprehensive education and access to seeds and improved agricultural techniques.

And, we're responding to this problem on an emergency basis, as well. We're providing immediate, life-saving treatment to severely malnourished children at our inpatient and outpatient therapeutic nutrition centers. These centers are all integrated into the local health system, so we're building the capacity of Ugandan health workers to sustain the fight against malnutrition and increase the number of children reached by these critical interventions.

You've done research on improving the nutritional intake of people living with HIV/AIDS. Why is proper nutrition so important in the fight against HIV/AIDS?

Adequate nutrition is necessary to maintain the immune system, manage opportunistic infections, optimize response to medical treatment, sustain healthy levels of physical activity, and support optimal quality of life. You can give someone all the anti-retroviral medications in the world, but they aren't going to work in the way they are designed to if the person is malnourished. This is an area we're really emphasizing because it's often lost in the discussion over how to fight the disease.

.Action Against Hunger is promoting a healthy, nutritious lifestyle for people with the condition. We're encouraging them to eat a variety of locally available foods in adequate quantities and combinations, consume foods that are fortified with essential micro-nutrients, eat nutritious snacks between meals, use micro-nutrient supplements in consultation with a doctor, seek prompt treatment for HIV-related conditions that affect food intake, and avoid habits that may interfere with food intake, absorption and utilization.

What's life like in Karamoja?

Karamoja is a semi-arid region where the main livelihood is pastoralism. Typically, the men tend to the cattle while the women stay in their settlements called manyata to do household chores and raise their children. What I find most fascinating in the Karamojong culture are the colorful garments and beads worn by the women and the small wooden stools men carry everywhere to rest when they get tired. I'm from eastern Uganda, so it's interesting for me to learn about the various customs in another region of the country.

You've described eliminating malnutrition among children under five and women of reproductive age as your life goal. What made you take up this work?

Uganda is often thought of as a 'food basket,' yet its malnutrition rates among children under five and women of reproductive age are still very high. Through my training as a nutritionist, I've learned that highly effective interventions don't have to be complicated or costly. There are relatively simple and affordable ways to lower malnutrition rates among the most vulnerable populations. This is an area where it's possible to make a big impact, so it's very satisfying work.