Feeding a child well in Uganda
Child malnutrition is usually visible before it is dangerous, and it is treatable in weeks once it is found. The practical work is knowing how to check a child at home, knowing what a balanced meal looks like using food that already grows nearby, and knowing what changes after a child is discharged from treatment so the same child is not back in six months.
Acute malnutrition is treatable, and the treatment is not complicated. What is harder is finding a child early, and keeping a treated child well once the sachets have finished.
These guides cover both halves: how to check a child at home and what the measurements mean, and how to build a diet out of what is actually available and affordable in a Ugandan village.
10 guides on this subject
Reading a MUAC band: what green, yellow and red mean
A MUAC band is a strip of plastic tape that measures around a child's upper arm, and the colour it stops on tells you how much muscle and fat that arm still carries. Measure the left arm at the point halfway between the tip of the shoulder and the tip of the elbow, with the arm hanging loose and relaxed at the child's side, and read the colour with the band flat against the skin and not denting it. Green means the child is not acutely malnourished today, yellow means the child is thinning and needs a health worker told as well as more and thicker food, and red means acute malnutrition that needs a health worker the same day.
7 minute read
What a therapeutic feeding course involves, week by week
A therapeutic feeding course treats a child with acute malnutrition at home, using a ready-to-use therapeutic food supplied by the health facility and a check-up every week. Most children are on it for roughly two months, though the exact length depends on the child, because discharge is decided by measurements and not by a date in a diary. The weekly check exists to catch a child who is not gaining, so they can be moved to inpatient care before they get into trouble.
8 minute read
Exclusive breastfeeding for six months, in practice
Exclusive breastfeeding means the baby takes breast milk and nothing else, no water, no porridge, no cow's milk, no herbal preparations, until they are six months old. Breast milk is mostly water, so a breastfed baby does not need extra water even in the hot months, and anything else given in those first six months displaces milk and carries whatever was in the cup with it. The difficult part is almost never the mother's ability to feed; it is the days she must be away, the person in the house who disagrees, and the widely held belief that a crying baby is a thirsty one.
7 minute read
Starting solid food at six months, and the year that follows
At six months a baby starts eating in addition to breastfeeding, not instead of it, and the food needs to be thick enough to stay on a tipped spoon rather than run off it. Start with a few spoonfuls of soft mashed food a couple of times a day, and build steadily so that by the first birthday the child is eating a small bowl at each family meal plus something in between. The two mistakes that cause most of the trouble are porridge that is too thin and meals that are too few.
8 minute read
Building a balanced plate from food that grows nearby
A balanced plate has three jobs to do: a staple for energy, something that builds the body such as beans, groundnut, silverfish, egg or milk, and something that protects it such as dark green leaves or an orange vegetable or fruit. Almost every household in Uganda already grows or can reach all three, and the usual problem is not availability but proportion, because the staple fills the plate and the other two turn up as a spoonful of sauce. Nothing in this guide asks you to buy an unfamiliar food.
6 minute read
Spotting a child who has stopped gaining, before they look thin
Growth faltering is when a child stops putting on weight, and it shows on the weighing card weeks or months before it shows on the child. To catch it, have the child weighed on the same schedule every month and look at whether the line on the card is still climbing, not at whether the child looks thin. Two flat weighings in a row, or one that has dropped, is a reason to act even when the child seems perfectly well.
7 minute read
A kitchen garden planted for a child, not for the market
Plant for the plate, not for the stall. A garden that improves a child's diet is built around three things: dark green leaves that can be picked two or three times a week, something orange such as pumpkin or orange-fleshed sweet potato, and a source of protein and fat such as cowpea, beans or groundnuts. Start with the leaves, because they are the fastest to arrive, and add the rest as the beds and the water allow.
7 minute read
The weeks after the sachets finish
Relapse usually happens in the two or three months after discharge, when the therapeutic food stops and the household goes back to the diet that did not work the first time. The task is to replace the sachets with something real: more eating times a day for that child, something added to every pot, and a weighing every month so a slide is caught while it is still small. Treat the discharge date as the start of the plan, not the end of the treatment.
8 minute read
Diarrhoea in a small child: what to do at home, and when to go
Diarrhoea harms a small child through water loss rather than through the stool itself, so almost everything you do at home is about keeping the child drinking. Start oral rehydration salts as soon as the diarrhoea starts, give small amounts very often rather than a cup at a time, and keep feeding and breastfeeding throughout. Go to a health facility the same day for blood in the stool, repeated vomiting, sunken eyes, a child too weak to drink, or diarrhoea running on for several days.
8 minute read
Feeding a child through illness, and the fortnight afterwards
Keep offering food and keep breastfeeding through the illness, in smaller amounts and much more often than usual, and accept that the child will eat less than you would like. The bigger opportunity is the fortnight after the fever breaks, when her appetite comes back stronger and the household can deliberately add a meal a day. Weight lost during illness is either regained in those two weeks or it is not regained at all.
8 minute read