Though Rwanda’s efforts to fight malnutrition and stunting among children under the age of five continue to make major gains, communities are still recording cases of malnutrition, including serious ones. According to the Demographic Health Survey (DHS) 2020, the percentage of stunted children under the age of 5 was at 33 percent, an indication that there is still a long journey towards dealing with the problem. Working with local government authorities, the Ministry of Health is using various measures, both preventive and diagnostic, to deal with malnutrition in different parts of Rwanda. For example, Kayonza district has established a special facility dedicated to treating children that are suffering from severe malnutrition, trying to revive them. Located at the Rukara Health Centre in Rukara Sector, the facility receives children under the age of 5 suffering from serious levels of malnutrition that require special nutritional attention. The children brought to this place are referred there by Community Health Workers (CHWs) who carry out screening in communities on a monthly basis, to monitor the growth and health of the toddlers. “When the CHWs find that a particular child is acutely affected by malnutrition, they refer the child to us. We look at the child, screen them, and compare our findings with those of the CHWs and we decide what to do,” says Jean Pierre Gasigwa, an official in charge of nutrition at the centre. After analysing their situation, mildly affected children are enrolled on treatment on an outpatient basis, while their severely affected counterparts are admitted, so that they will get more serious care. Care for the severely malnourished children is provided in line with the MoH protocol which offers guidelines in regard to not only how to feed them, but also how to treat the medical condition s like swollen feet and bacterial infections that they might be suffering from as a result of malnutrition. The facility has rooms that have a number of beds where the children and their mothers sleep while being admitted, a kitchen for cooking for the children, a garden that has fruits, vegetables and other types of food for feeding the children, while it also has some supplies of supplementary and therapeutic foods from the MoH for treating and reviving the children. While here, the children’s health is monitored by a nutritionist who is assisted by some casual workers who cook for them, as well as assisting their mothers to learn more about nutrition. The admitted children can spend time here ranging from a few weeks to 4 months, depending on how quickly they recover. After getting well, they return to their homes, but CHWs continue following up on their families to make sure the children are given the necessary care so that they will not be affected by malnutrition again. Since malnutrition is caused by a number of problems in families, for example neglect of children, domestic violence and poverty, there are several measures that the local authorities try to put in place in an attempt to ensure that the once-affected children will not be victims of such circumstances again. Here for example, if a certain family is poor and that happens to be the reason for malnutrition among their children, the parents are advised to attend “Iziko,” a daily exercise where mothers of children that are facing nutrition challenges gather to cook for them, using food stuffs that the parents bring from their respective homes. In addition to this, vulnerable families are also given work opportunities in VUP programs, so that they can earn some money to sustain good feeding for the children. This is complemented by other government programs like “shisha kibondo,” a nutritious flour that is provided to poor families for feeding their babies, among other initiatives in place. Gasigwa notes that there is a need to sensitize parents about nutrition more and more, because many have little knowledge about it. Dativa Nyiruguhirwa, one of the mothers of the malnourished children admitted at the facility when The New Times visited it last week, confessed that she had less knowledge about nutrition when she gave birth to her first child, and that is one of the reasons that she became affected by malnutrition. This was coupled with the fact that she was poor and did not have enough resources to buy fruits and milk which are some of the food stuffs that comprise a balanced diet. After being admitted at the facility, the child is improving, but still, one cannot help but fear that may slide back into malnutrition after getting discharged. However, Nyiruguhirwa is optimistic that she will do better this time around. Alphonse Ngarambe, the health officer of Kayonza district says the district has made some good improvement in fighting stunting but there is still need for more efforts, one of which is sensitization. According to the Demographic Health Survey (DHS) of 2015, stunting among children under the age of 5 in Kayonza was at 42.4 percent in 2015, but there was some good improvement in 2020 as the figures went down to 28.3 percent. A community health worker who prepare different meals to the beneficiaries. / Courtesy A mother with her child who is one of the beneficiaries of the initiative to recover the malnourished children in Kayonza District. / Courtesy
