Between 2016 and 2017, the United Children’s Fund (Unicef) rolled out mass screening of children for early diagnosis and treatment of malnutrition. Although there was high rise in children getting screened at community level and children being referred to health facilities for free services, there is low access and utilisation. Unicef engaged the Applied Development Community and Training Services (Adecots) on a campaign to increase access. KONDWANI KAMIYALA talks to Adecots executive director Mercy Simbi to get more. Excerpts:
Give us a brief background to the campaign.
Under the Community Management of Acute Malnutrition [Cmam], Unicef supported mass screening for diagnosis and treatment of malnutrition. That was between 2016 and 2017. Although services for children diagnosed with moderate, acute and severe malnutrition have been free since February 2017 under the programme at public and Christian Health Association of Malawi [Cham] hospitals, access turned out to be low. That is where the campaign and mobilisation had to come in.
What are the objectives for the campaign?
We seek to raise awareness, mobilise communities and create demand on the free nutrition services available in both public and Cham facilities in Dedza, Chikwawa, Thyolo Nsanje and Salima. We also want to promote active case finding, increase knowledge of good nutrition practices and promote health-seeking behaviours among parents, caregivers and traditional leaders. Parents whose children arediagnosed with malnutrition or at risk of malnutrition must adhere to appropriate services including Outpatient Therapeutic Programme [OTP], Supplementary Feeding and Nutrition Rehabilitation Unit [NRU]. The campaign also promotes long-term positive infant and young children feeding practices that will sustain the improvements in nutritional status for children.
What were the processes in the campaign?
We first did a situation analysis by engaging communities in the five districts which ascertained attitudes, behaviours, perceptions and beliefs on acute malnutrition. The findings were validated by the hospital advisory committee and district nutrition team and provided a basis for development of micro-plans for each district and key messages for community and radio drama storylines.
What were some of the findings?
It was found that some traditional beliefs made some parents believe that a child’s malnutrition was the result of witchcraft or not following some cultural norms. Instead of going to the hospital, they were going to traditional healers. On the other hand, some mothers were giving supplements from the hospital to their husbands or the whole family. Others were selling the supplements. Lack of information on the free services was another problem.
After the analysis, what was next?
We mobilised various district and community groups where we conducted orientation meetings for activities including community dialogues and interactive theatre. We have been working with district nutrition teams, Cham management, traditional and religious leaders, frontline health workers including health surveillance assistants, care groups as well as households. This is key in ensuring early detection of malnutrition at community level and referral to health facilities.
What role can chiefs and traditional healers play?
We urged chiefs to formulate by-laws that would motivate parents to seek treatment from health facilities. We are mobilising and orienting traditional healers who often treat children suffering from malnutrition on the belief that they have been bewitched to take lead in referring mothers, caregivers and parents of children at risk or suffering from malnutrition to health facilities.
Tell us more about the theatre
We trained 72 interactive theatre groups in 30 T/As in the five districts to promote community dialogue, community participation and interrogate the cultures and beliefs. The groups in collaboration with care groups develop creative messages and engage communities in malnutrition, cultural issues, exacerbating malnutrition as well as finding solutions to the problems which include promotion of behaviour change and adoption of health seeking behaviour for the treatment of children suffering from severe and moderate acute malnutrition. They conduct two performances each week and are monitored by our field outreach assistants. After a performace, children are screened and those diagnosed with malnutrition are referred to the hospital. We are also using community radios to spread the word through a 15-minute play. We have Gaka FM in Chikwawa, Nyathepa FM in Nsanje, Mzati FM in Mulanje, Chisomo FM in Salima and Bembeke FM in Dedza.
What do you expect to achieve?
When the six-month campaign comes to an end in August, we expect at least 60 percent of under-five children to access quality nutritional services that would prevent and cure malnutrition, while at the same time promoting balanced diets. That would translate into 121 439 children accessing the services in public as well as Cham facilities by next month. We also targeted 470 000 parents, care givers and members of the community at large on the key signs and symptoms of malnutrition and where a child is diagnosed, they should be taken to the hospital. We also wanted to reach out to about 470 traditional leaders and over 1 200 traditional healers to act as agents of change, where nutrition is concerned.