By Meritt Buyer
13% of the children enrolled in Building a Caring Community suffer from malnutrition. That means about 26 of BCC’s 200 children are malnourished. In order to address the issue in a relevant and sustainable matter, we need to look at more than numbers. The numbers only let us know there is a problem, not the causes or the solution. Given that BCC provides 2 meals a day for all the children in the center, in most cases, the problem is probably not that the kids are not getting food, but how and what they are eating. The staff of BCC and Mosaic International has made previous attempts to address the problem, but little progress was made. After receiving the data from this year’s screening confirming the ongoing issue, Godson Mmary, our Promot Health Coordinator changed tactics.
Godson, together with Mary Masenga, a nutritionist at the local hospital, sought to understand the root of the problem. First, Godson and Mary visited every single child that had been identified as at risk for malnutrition. They measured and weighed each child and noted the severity of their condition. They spoke with the parents about each child’s medical history and diet. When they felt they understood the issue and its causes they began to develop an approach.
Relying on the information from the individual visits, Mary and Godson conducted an all day seminar for the entire BCC staff. Then they gave similar presentations at each center for parents. BCC has done seminars for parents in the past on this issue. But there have not been significant results. Godson thought a new approach was needed. If he ran seminars in each center, parents would be more likely to be able to come and might feel more comfortable asking questions in a smaller group. Also, he and Mary would be able to speak with them on an individual basis about their children.
At each seminar, Mary explained in detail the need for balanced meals that include substantial amounts of fruits and vegetables as well as protein and carbohydrates. The traditional Tanzanian diet is heavy on the carbohydrates, usually includes a bit of protein, and very light on fruits and vegetables. In the centers, the children are fed a traditional porridge (uji) in the mornings and a large late lunch. Historically, the center staff has tried to make additions to the porridge for variety, but they usually just add more carbohydrates. Godson has been working with staff and parents alike to encourage them to add milk, soy, bananas, or peanut butter to the porridge. He has also been helping them to use their current budget to plan healthier meals for the centers. Mary explained that one of the issues she regularly comes across is the strongly held belief that vegetables are too expensive. She and Godson are helping the staff and parents to understand how to include vegetables on a daily basis without overspending.
Physical disabilities are definitely a compounding factor in the issue of malnutrition. BCC has many children with Cerebral Palsy and other physical disabilities that cause them to have difficulty swallowing. In the United States and Europe, most of these children would likely be fed through a feeding tube. Since that is not an option here, we need to make every little bit of food that gets to their stomachs count.
So in addition to altering the menus in the centers, BCC is now providing nutritional supplements to those children who are malnourished, both for those in the centers and in in-home services. The supplement is a simple high calorie powder that can be added to porridge, juice, and other readily available foods. In addition, Godson has budgeted for the children to receive fresh milk every day.
So we will watch and see what happens. We need to collect more data to see if this initiative will be a success. Godson is continually following up with center staff on meal preparation. The outreach workers have been instructed to prioritize visiting the children on nutritional supplements and to document any changes. All children are being weighted weekly and the data is being recorded.
This initiative illustrates so many positive practices in development strategy. Collecting data, having a full understanding of the problem and its underlying causes, integrating personal experiences into the solutions, presenting solutions in an accessible manner, and monitoring progress. Hopefully, the data from next years screening will show a lot more kilograms for the children of BCC!