Kisiizi Malnutrition Project (KMP)

Background

KMP was set up in 2015 by the paediatric team at Kisiizi, including visiting doctors Sunil Esampalli and Katie Mayers. It was born from a realisation that due to the hospital’s status as a private-not-for-profit organisation, malnourished children were not getting full access to what the WHO would regard as gold standard care, the main problem being the lack of ready to use therapeutic food, a calorie dense paste forming an essential part of nutritional rehabilitation. The project was set up to subsidise the costs of inpatient care for families, and with a plan to reach out into the community for preventative work in the future.

The logo for Kisiizi Nut, the name given to our hospital-produced ready to use therapeutic food

Why is the project necessary?

Malnutrition is one of the most complex and insidious challenges to child health – UNICEF estimates that malnutrition underpins at least 50% of deaths in under 5 year olds. In Kisiizi, our data suggests that around 40% of children who die are malnourished, but this may be an underestimate. It is a multifactorial problem reaching across all areas of society, with poor access to contraception, early cessation of breastfeeding, gender inequality, and the high cost of land all contributing locally. Children who do not die are often delayed both in terms of their physical growth and neurological development, and are likely to fall behind their peers at school, trapping them further into a vicious cycle of generational poverty.

Kisiizi is a mission hospital with a private-not-for-profit model which means unfortunately that hospital care is not free. There is an innovative and cheap health insurance scheme, but often for the poorest families, even these minimal membership costs are too dear. This means that for the poorest families whose children are most likely to become unwell with malnutrition, admissions can be extremely costly, with families having to provide food and pay for medicines throughout the duration of a hospital stay. Children with acute severe malnutrition often need upwards of 4-6 weeks in hospital to recover fully, but families often leave before this time due to financial constraints.

In addition, because Kisiizi is a private-not-for-profit hospital, it does not qualify for supplies of ready to use therapeutic food (fortified peanut butter) from international agencies as a public hospital would, meaning that this critical part of recovery treatment was for many years not available.

Aims of the project – current and future

The aim of the project at present is to improve the quality of inpatient care available to children and to optimise nutritional rehabilitation and reduce the costs of care for families.

What does KMP currently do?

Currently, the ways in which we have improved the quality of inpatient care and optimised nutritional rehabilitation are:

  • Updated guidelines in line with WHO recommendations – our local guidelines were reviewed and updated in 2015 to bring them up to date with WHO recommendations
  • Provision of locally made ready to use therapeutic food – fortified high calorie peanut butter is now made in our pharmacy on demand and provided free of charge to children who need it as part of their care once their appetite has returned. The paste stores well in individual portions with a long shelf life and no refrigeration requirements. KMP raised the capital for the equipment required, and covers the ongoing ingredient costs.
  • Provision of supplemental food to reduce costs to families – KMP raised the capital for a demonstration garden and chicken coop. Fruit and vegetables grown in the garden are provided for families free of charge, as are eggs from the chickens. If there are excess eggs or produce, these are sold and the money put back into the project. We cover the ongoing costs of this including the salary of the garden and coop caretaker.

We have also worked with other departments and projects. For example, the work of the USHAPE scheme at Kisiizi has improved access to contraception for mothers on the paediatric ward by training nurses on the paediatric ward to be able to counsel and provide women with long acting contraception either for free or at a low cost, in addition to extensive education programmes for all staff.

Clockwise from top left: ready to use therapeutic food in the mixer; the chicken coop; the demonstration garden; ready to use therapeutic food being prepared by pharmacy staff

The future

We plan to initiate a community programme aimed at early detection and treatment of malnutrition, alongside community empowerment and mobilisation. We have already collected the data from our hospital records which shows us which parishes locally are the worst affected by malnutrition, and will target these areas first. We would aim to support the finances for this stage of the project through a research/development grant. The community programme would potentially include:

  • Identification and training of community health workers who are already respected community members to improve knowledge and early detection of malnutrition, encourage breastfeeding and birth spacing etc
  • Early identification of malnutrition through community screening
  • Encouragement of farming techniques which require less land to grow nutritious crops ie bag gardens, communal allotment-style farming
  • Provision of chickens/goats to families to support children’s nutrition and finances
  • Possibility of microfinance options to empower women and enable them to set up small businesses
  • Encouragement of communities to join the hospital health insurance scheme, cushioning the poorest families from financial disaster
  • Education and sensitisation programmes and events to improve knowledge and health seeking behaviours

Next steps

We aim to reduce the costs of inpatient care further for families by paying the salary of the main nurse allocated to care for the malnourished children on the ward, and the salary of the nurse who currently going into the community to facilitate follow up and maintain links with vulnerable families. If we are able to cover the costs of admission in terms of treatment and staff time, we might be able to introduce a flat rate admission, where instead of families paying cumulatively for long admissions, they will pay a small charge at the outset and then be able to stay as long as the child needs. This would make children much more likely to stay until they are fully recovered, rather than leaving as soon as the immediate dangers from acute illness have passed.

How you can support the project

Financial support

We try to encourage unrestricted giving through Kisiizi Partners rather than to individual projects because this gives the hospital the ability to use funds flexibly where they are most needed. However, the running costs of KMP are between £150-300/month depending on whether we include paying staff salaries, and as a charity we have made a commitment to encouraging regular donations to the project to allow it to be financially sustainable.

To give specifically to KMP, you can:

Technical or professional assistance

The project is overseen in Kisiizi by the paediatric ward nursing staff in Kisiizi and by our paediatricians Dr Josephine Mugume and Dr Ian Spillman, with UK oversight from Katie Mayers. We are keen to welcome expertise from others who may have suggestions for how we can improve the project either from an inpatient or community perspective, or those who might be running similar projects and have experience to share. Please feel free to get in touch with us via katie@kisiizipartners.org.uk. Equally if you would like to know about how we make our ready to use therapeutic food or any other details of the project, we are happy to share our experiences via the same contact.

Celebration of the opening of the chicken coop and demonstration garden with senior hospital staff, paediatric staff and families from the ward.