Case Study: Training up local health workers in Uganda

Malnutrition is a global health problem affecting one-in-three children and the leading cause of morbidity and mortality among children under five years. However, there has been limited focus on preventing and managing malnutrition among infants less than six months compared to children six to 59 months. As a result, malnutrition in infants under six months remains prevalent, poorly reported, and mismanaged because of the limited evidence available to inform policy and practice.

Why is there a lack of evidence? One reason is because children under six months are often excluded from nutrition surveys and programs because there is no approved mid-upper arm circumference threshold for this age group, which makes screening children of this age group difficult.

There is also the wrongful assumption that infants under six months are exclusively breastfed and therefore less susceptible to malnutrition. However, reality shows that this is not the case. In fact, the number of children this age that are exclusively breastfed across the world has fallen well below 50 percent.

The evidence that is available is confronting. A recent analysis of demographic health surveys from 56 countries estimated that 18 percent of newborns were born with a low birth weight (<2500g). Among infants younger than 6 months, they reported that 20% were underweight (WAZ<-2), 21% were wasted (WHZ<-2) and 17% were stunted (HAZ<-2). Without proper care and treatment, these small and nutritionally at-risk infants less than 6 months could die or suffer from poor growth and stunted development.

Addressing gaps in MAMI programming in Uganda

In January 2022, Action Against Hunger in Uganda carried out a contextual analysis for MAMI (the Management of small & nutritionally At-risk Infants under six months & their Mothers) in Kiryandongo and Adjumani Districts. They found that a large proportion of the small and nutritionally at-risk infants under six months and their mothers were not being identified nor was there an existing continuum of care from birth up to 6-months of age to support mothers and their young infants to survive and thrive.

To address these gaps, Action Against Hunger Uganda decided to pilot the MAMI Care Pathway Package as part of their multi-sectoral humanitarian response to the deteriorating nutrition situation in Kiryandongo and Adjumani refugee settlements in the Western and West Nile region of Uganda – home to predominantly South Sudanese refugees. The pilot targeted 21 health facilities and the catchment communities.

It became clear, however, that to fill these gaps successfully, more technical support was needed to strengthen the local health systems’ ability to support these small and nutritionally at-risk infants and their mothers. Action Against Hunger Uganda also noticed that their staff needed to further develop their understanding and ‘how-to’ in order to properly implement the MAMI Care Pathway – a resource to screen, assess, and manage small and nutritionally at-risk infants under six months and their mothers.

Upon request, the Alliance’s MAMI Advisor, Alice Burrell from Save the Children, was deployed to Uganda to help Action Against Hunger Uganda mentor and upskill their national health teams as well as strengthen the capacity of national MAMI champions and work together with the government to raise awareness of MAMI among national organizations, government workers, health workers, and other NGO staff in Uganda.

The support provided included:

Providing on-the-job supervision and coaching for Action Against Hunger Uganda’s staff on current MAMI implementation in Adjumani and Kiryandongo refugee settlements

Developing an ‘Action Plan’ based on observations of supervision to continue building capacity of staff on MAMI and the quality of implementation and service delivery

Help refining M&E tools, including development of a MAMI supervision tool

Preparing and delivering a 5-day MAMI technical training for staff, with help from national focal points in MAMI, IMCI and IYCF

Providing an orientation on MAMI to the national nutrition sector and relevant national stakeholders

Training upwards

Alice’s time in Uganda proved fruitful – particularly in terms of closing the knowledge gap around MAMI among the team at Action Against Hunger Uganda. Participants of the training reported feeling better equipped to implement MAMI in their work within communities.

The hope moving forward is that, now better positioned, Action Against Hunger Uganda can drive the dialogue around MAMI among stakeholders and share their new knowledge, tools and resources at the district, regional, and national level to improve care for these vulnerable women and babies across the country.

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Source: UN Children's Fund

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