Empowering Refugee Communities through Proactive Nutrition Initiatives

Every month, the community gathers for a Village Health Committee meeting under Primary Health Care and Community Empowerment Initiative (PHCCEI) led by the area chairman, Mugisa William. During these gatherings, children are monitored for any nutrition challenges with growth monitoring equipment like MUAC tapes, height boards and Salter weighing scales provided by UNICEF with funding from UKaid. Mothers are also counselled by members of the Village Health Teams (VHTs) on best nutrition practices and sensitized through dramatic presentations of music and dance.

 “In 2022, the district health team officials came and assessed the community and noted several challenges. We then formed a Village Health Committee and produced an action plan which tackles all the pain points they identified,” Mugisa says. 

Their commitment to this action plan is evident in the tangible results seen through the quelling of malnutrition in the village and success in implementing complementary projects like improved access to safe water and cultivation of kitchen gardens.

 Emmanuel Tumusiime, a Kamwenge District local government nutritionist, underscores the significance of adherence to the PHCCEI action plan by the VHTs in addressing nutritional deficiencies comprehensively. 

“Central to Rubaba Village's success is the pivotal role played by VHTs, whose training equips them with the knowledge and tools to screen for malnutrition at community level. Armed with growth monitoring equipment and nutritional training from UNICEF, VHTs engage mothers, sensitize communities, and refer cases to health centres for further management, when necessary,” Tumusiime says. 

The statistics in Rubaba Village are promising and the leaders consistently refer to it as a malnutrition-free zone. Kwebiha Agnes, a VHT, says that they are not about to relax while explaining that this stringent adherence is why their village maintains its green status.

 "We haven't always been malnutrition-free," she explains. "When we started our work, a few cases were identified as red and referred for further management at the regional referral hospital, while the yellow cases were managed by the VHTs. We are always alert as we comb through the village looking out for any new cases. The good thing is that our mothers are also supporting these efforts from their homes by using MUAC tapes to monitor their children and making sure their children are eating nutritious meals.” 

Among the caregivers attending the meeting is 65-year-old Beatrice Bonabana, who has brought her one-and-a-half-year-old grandson, Godwin, to the meeting. She says the child was left in her care after her daughter-in-law abandoned her son. With limited resources and lacking proper education, Bonabana fed the child the same food she ate at home, leading to his malnourishment. 

“Fortunately, a VHT visited us during a monitoring visit and discovered that the child was in the yellow zone. They taught me how to properly feed Godwin by teaching me how to make a locally made multi-mix meal called ‘ekitobero’ which resolved the malnutrition soon after.” 

Kebirungi Medinah, the Rubaba PHCCEI Ward Agent, says that the mothers in the area have always had access to plenty of food because the Tooro sub region where Rubaba Village is found is food-rich, however there was a gap because mothers lacked basic nutrition knowledge. “Caregivers in the area previously fed children with carbohydrate rich food like cassava and mandazi while ignoring other food groups including proteins and vitamins but thanks to the VHTs knowledge sharing efforts, the mothers are now well informed," Kebirungi reflects. 

Kebirungi vividly remembers the case of 5-year-old Catherine, who was left in the care of an elderly grandmother struggling with alcoholism. By the time she was discovered, Catherine was in the red zone because she was neglected and only fed with cassava. The child was placed in the care of a compassionate caregiver by the village leaders and underwent aggressive treatment by the VHTs with ekitobero and Ready-to-Use Therapeutic Food (RUTF) provided by UNICEF. 

"As I speak now, Catherine is in perfect health," she says.

Stunting in Tooro

 However, challenges persist, particularly in the Tooro sub-region. Tumusiime says that Tooro has the country’s highest levels of stunting, a condition where a child is too short for their age due to chronic or recurrent malnutrition, reaching 42 per cent. He explains that stunting has far-reaching effects, including the impediment of physical growth and cognitive development. 

Statistics from the Ministry of Education and Sports, show that the average result in Kamwenge District in the 2023 Primary Leaving Exams was a dismal 21 aggregates. Tumusiime attributes this concerning performance to the high prevalence of stunting in the district, emphasizing its link to consequential cognitive impairment among children.

 The World Health Organization highlights that malnutrition during the critical periods of growth and development, especially in early child[1]hood, can lead to irreversible cognitive deficits. 

Despite these challenges, Tumusiime remains optimistic that ongoing nutrition interventions in Kamwenge District will contribute to significant improvements in school performance over time. 

“Addressing the root causes of stunting and its associated cognitive impacts and implementing interventions like those in Rubaba Village hold promise for fostering a healthier and more academically successful future for the children of Kamwenge District,” he says. 

A concerted effort 

Sharon Nalunkuuma, a program manager with Kabarole Research and Resource Centre at the Kyaka II Refugee Settlement field office in Kyegegwa District says UNICEF’s role is deeply intertwined with other actors in the pivotal task of addressing malnutrition in the refugee communities across western Uganda. 

“Preventing malnutrition requires a comprehensive approach, encompassing maternal and child health alongside nutrition interventions. Working in close partnership with UNICEF, we have recognised that addressing stunting—a chronic issue requiring long-term support— is essential for ensuring the overall well-being of our community. To tackle stunting effectively, we have developed strategies in collaboration with UNICEF, including strengthening the care group approach,” Nalunkuuma says. This has all been possible with funding from UKAID.

Care groups, comprising at least 10 mothers with children under two years or those who are pregnant, serve as vital channels for disseminating information and fostering community support.

 “By identifying mothers during antenatal and immunization visits and organizing them into groups, we facilitate peer-to[1]peer education and knowledge sharing,” she says. 

In his capacity as a nutritionist at Kikuube District, Albert Mugabi highlights that UNICEF has supported efforts to scale up nutritional interventions, particularly micronutrient interventions and the management of acute malnutrition for children. 

“UNICEF has aided in capacity-building efforts at the national level by training trainers and supporting regional rollouts. At the regional level, they train district teams who, in turn, educate community teams on various aspects of nutrition, including integrated management of acute malnutrition. Additionally, they provide support for deworming, vitamin A supplementation, food security, and routine outreach programs for nutritional assessment,” Mugabi says.