219359 Initiative to End Malnutrition: A local, effective, and affordable model in the Rukungiri District of Uganda

Tuesday, November 9, 2010 : 12:48 PM - 1:06 PM

Keri Cohn, MD, DTMH , Children's Hospital Boston, Massachusetts General Hospital Division of Global Health & Human Rights, and Harvard Medical School, Boston, MA
Sarah Nam , Global Hunger Initiative, Harvard College, Cambridge, MA
Gordon Liao , Global Hunger Initiative, Harvard College, Cambridge, MA
Junghyun Lim , Global Hunger Initiative, Harvard College, Cambridge, MA
John Bosco Kamugisha, RN , Karoli Lwanga Nyakibale Hospital, Rukungiri, Uganda
Mark Bisanzo, MD , Massachusetts General Hospital Division of Global Health & Human Rights and Karoli Lwanga Nyakibale Hospital, Boston, MA
Thomas F. Burke, MD , Division of Global Health & Human Rights, Massachusetts General Hospital, Harvard College Global Hunger Initiative, and Karoli Lwanga Nyakibale Hospital, Boston, MA
Background: Malnutrition affects 25% of the world's children, contributing to more than half the annual 11 million deaths of children under 5. A staggering 30-40% of children under 5 in Rukungiri District of Uganda suffer from acute or chronic malnutrition, yet this crisis remains unaddressed. Purpose: Through education, empowerment of local health workers and the community, create a reproducible, affordable, and sustainable model to identify and systematically treat malnutrition within a rural Ugandan District. Methods: 28 specialized hospital staff, including physicians, pediatric nurses and emergency care providers, were trained in a locally-tailored malnutrition treatment protocol, making Nyakibale District Hospital a referral center for severely malnourished children. A financial analysis was conducted using local products to create a low-cost, sustainable program. An executive committee of local staff was created to manage the program and conduct monthly assessments of intervention-related outcomes. 28 community health providers at 3 health centers were certified in identification of pediatric malnutrition and indications for referral. Nutritional education training was integrated into routine outpatient care. Groundwork for further community health involvement and in identification of barriers to proper nutrition have been established. Results: 1 to 2 severely malnourished children are admitted daily. A financially sound, sustainable, potentially reproducible model to identify and systematically treat malnutrition through education and empowerment of local medical staff and community is underway, with long-term feasibility and intervention-related outcomes to be determined. Conclusions: We present a methodology and model for implementation of an effective, locally-managed, sustainable and affordable program to address a malnutrition crisis.

Learning Areas:
Administer health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning
Provision of health care to the public
Public health or related education
Social and behavioral sciences

Learning Objectives:
1. Describe the priorities in designing a strategy to address regional malnutrition 2. Describe a model of an education-based, locally sustainable, affordable, protocol-driven approach to childhood malnutrition in rural Uganda.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present this abstract because I am a pediatrician trained in tropical medicine and hygiene and am the Director of the Initiative to End Childhood Malnutrition at the Division of Global Health and Human Rights at Massachusetts General Hospital in Boston, MA. I am also an instructor at Harvard Medical School.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.