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Malnutrition battle far from over


A nurse inspects Paballo’s tinny body at Berea District Hospital

. . . as aid agencies step up assistance

Pascalinah Kabi


CRYING helplessly in a hospital bed, *Paballo looks more like a three-month old infant than the 10-month old baby that he is.

The Sunday Express crew this past week visited Paballo at Berea District Hospital where he had been admitted last Sunday for constant vomiting and oedema — a build-up of fluid in the body which causes the affected tissue to become swollen.

The swelling can occur in one particular part of the body or may be more general, depending on the causes, which include malnutrition.

According to the World Health Organisation (WHO), in children who are six–59 months of age, severe acute malnutrition is defined by a very low weight-for-height/weight-for-length, or clinical signs of bilateral pitting oedema, or a very low mid-upper arm circumference.

The WHO also notes that children with severe acute malnutrition who have severe oedema (+++) have an increased risk of mortality compared to children with severe acute malnutrition but with lesser degrees of oedema.

The visit was part of a media tour organised by the United Nations Children’s Fund (UNICEF) to assess its initiatives in response to the 2015-16 El Nino-induced drought that left over 600 000 Basotho food insecure.

Paballo’s mother told this publication she decided to bring the infant to the hospital after his health continued to deteriorate.

“He started vomiting when he was three-months old, and the vomiting could come and go. But at six months, it got worse and I rushed him to the hospital,” she said.

“That is the period he was hospitalised for the first time, and we stayed at the hospital until the doctors were satisfied with his recovery process and eventually discharged.”

However, the vomiting continued until she decided to completely stop breastfeeding Paballo when he was nine-months old, after she suspected that the breastmilk was making her baby sick.

“By that time, I had already started giving him supplementary foods like home-made soft porridge since he was vomiting every time after breastfeeding.

“I concluded that the breastmilk had something to do with the vomiting.”

Last Sunday, she woke up to see her son’s tiny body swollen and immediately rushed to the hospital where she was informed that he had oedema, a symptom of malnourishment.

“I have six older children and this is the first time to experience something like this,” the 42-year-old said.

“All my children grew up without such health complications and at times I blame myself for his condition.

“The doctors have told me to make sure my child eats nutritious foods to enable him to fully recover from oedema.”

While Paballo’s case might seem isolated in Lesotho, officials at the Berea District Hospital indicated they had seen 15 malnutrition cases between April and June 2017; an indication that Lesotho was struggling to redress this problem.

Little Paballo is one of an estimated 19 million under-five children suffering from severe acute malnutrition and estimated to account for approximately 400 000 child deaths globally each year, according to the WHO.

The Lesotho Cost of Hunger Report has also stated that between 2008 and 2014, there were up to 9 272 child mortalities in Lesotho directly associated with undernutrition, representing 19.5 percent of all child mortalities for this period.

Berea District Nutritionist, Tšongoane Mpota confirmed that Paballo was suffering from acute malnutrition.

“Medically, we can safely say the baby is suffering from severe malnutrition,” she said.

“The mother’s perception that the vomiting was caused by breastfeeding is very wrong. She did not exclusively breastfeed the baby as was recommended by doctors.”

Ms Mpota said she suspected that Paballo’s mother had resorted to unhealthy food supplements like a sugar-water solution.

“There is a high possibility that she might have used unclean water to make the popular sugar-water solution and that in itself contributed to the child’s worsening condition.

“Introducing foreign foods to a three-month-old baby can induce vomiting and diarrhoea and it gets worse if hygiene standards are not adhered to.”

Asked if it was possible that the child had been born with the condition due to the mother being malnourished, Ms Mpota said children could be born stunted due to their mothers’ health and nutritional conditions.

She indicated that it was worrisome that more Basotho mothers were giving their infants alternative foods to breastmilk before they were six- months-old.

“Pregnant mothers who attend antenatal clinics are trained on the importance of exclusive breastfeeding for six months. But others don’t adhere to this provision, putting their babies at risk of being malnourished.”

Asked if there was still hope for little Paballo to recover, Ms Mpota said malnutrition was reversible as long as parents and guardians ensured that children ate nutritious foods.

“His mother can still lactate and breastfeed him because a mother’s milk is the best option in this case,” she said.

Another nutritionist said a main cause of malnutrition in Lesotho was endemic poverty.

“Poverty is the main factor in this whole scenario. Between April and June, we had 15 cases of malnutrition and three of the children died,” the nutritionist said.

“This child will recover and go home. Even though the mother will be given Ready to use Therapeutic Foods, you will find that the child may have to share the food with all his siblings compromising his chance to fully recover.”

The hospital offers free medical services to Paballo and his mother under a memorandum of understanding signed between the government and UNICEF to ensure that children led a healthy lifestyle across the country.

The memorandum was signed as a part of efforts to respond to the El Nino-induced drought which devastated Lesotho’s food security.

UNICEF Child and Health Coordinator Toni Asije said they were concentrating on offering hand-wash and water storage facilities to different healthcare facilities in Butha-Buthe, Leribe and Berea; serving about 60 000 people.

“You will know that Lesotho has a very high child stunting rate of 33 percent as per the last Demographic and Health Survey, meaning that one in every under-five years-old children is stunted,” Dr Asije said.

He said that UNICEF intervened by procuring and distributing therapeutic foods to healthcare facilities to address acute malnutrition across the country’s districts.

Dr Asije also indicated that the programme targeted over 2 000 children under the age of five with severe acute malnutrition, adding that they were ultimately able to serve over 5 000 children.

The World Food Programme (WFP) has also provided assistance through its ongoing school feeding programme catering for 380 000 children across the country.

According to WFP Country Director Mary Njoroge, the programme was meant to cushion the children from malnutrition.

“It acts as a safety net to make sure that the kids go to school. In addition to that, there is an Early Child Centre for Development feeding programme which caters for 50 000 children meaning that the young children can also go to school,” Ms Njoroge said.


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