​What kinds of symptoms do patients experience before receiving treatment?

At our medical partner's care center, Bwindi Community Hospital, two types of malnutrition are treated on an in-patient basis: moderate acute malnutrition and severe acute malnutrition. Moderate acute malnutrition (MAM) is also called “wasting” and is characterized by low weight-for-height indicators or by low mid-upper arm circumference (MUAC) indicators. Severe acute malnutrition (SAM) is the most dangerous type of malnutrition. It is caused by extreme deprivation of vital nutrients and becomes life-threatening because of its alterations of important functions of the body. SAM can manifest in two ways: severe wasting and oedema. Severe wasting is caused by extreme nutrient and calorie deficiency. Its symptoms include a massive loss of body fat and muscle tissue. This results in “baggy pants syndrome," in which the skin is loose while the body is extremely thin. Malnutrition of this type is also called marasmus. Oedema is caused primarily by the deficiency of protein in the diet. The body's extremities become extremely swollen. The oedema then progresses to the face and other areas of the body. Other symptoms include skin lesions, an enlarged liver, and changes in hair color. Malnutrition of this type is also called kwashiorkor. Kwashiorkor is the most common type of malnutrition treated at Bwindi Community Hospital.

​What is the impact on patients’ lives of living with these conditions?

If not treated, moderate acute malnutrition can quickly progress to severe acute malnutrition. Chronic malnutrition can cause long-term growth and development issues, such as stunting and reduced cognitive capacity. Untreated, severe acute malnutrition can result in death.

What cultural or regional factors affect the treatment of these conditions?

There are many underlying causes of acute malnutrition in sub-Saharan Africa, including poverty, family size, lack of nutritional knowledge, mental health issues in caregivers, disease, war, social problems, and lack of clean water. Treatment is necessary to prevent malnutrition from becoming chronic and having a long-term impact on a child's development.

What does the treatment process look like?

Bwindi Community Hospital has a robust program for the treatment and prevention of malnutrition. Combining multifaceted community education, the assessment of nutritional status of children, and treatment of acute malnutrition, its goal is to prevent all forms of malnutrition. Hospital in-patient treatment, supported by Watsi, is reserved for the most acute cases. Every three months, the hospital’s Community Health Nursing Team (CHT) works with Village Health Teams (VHTs) to assess the nutritional status of all of the approximate 10,000 under-five children in its catchment area. Milder cases of malnutrition, which are the majority, are referred to district health centers for management. Early case-finding and treatment prevents progression to life-threatening, expensive, and complicated malnutrition. In addition, the CHT and VHTs conduct health education classes for the community. Subjects covered include family planning, sanitation and hygiene, maternal health, and prevention of illness. All of these issues are related to malnutrition. Once admitted to the hospital, a child is given a series of milk formulas. These formulas are calibrated to carefully increase nutrient and protein intake. After the formula phase, the child transitions to “Ready to Use Therapeutic Food” (RUTF). At Bwindi Community Hospital, the RUTF is a peanut butter-based food called plumpyNut™. It is nutrient-rich and packed with a high concentration of protein and energy. Supplements, such as Vitamin A and folic acid, are given. Antibiotics are given, if needed, to treat concurrent infections. After transitioning to the RUTF, the child is given an appetite test. If he or she eats well, the child is discharged and returns home with a supply of plumpyNut™ to supplement local foods. While the child is in the hospital, his or her caregiver receives health and nutritional education, including cooking classes, to help prevent recurrence of malnutrition. Food from a demonstration nutritional garden is used in the cooking classes and provided free to patients. When discharged, the child is referred to a local health facility and community nurse for follow-up. The child continues receiving treatment and supplemental food until his or her goal weight is reached.

What is the impact of this treatment on the patient’s life?

If the correct treatment is started promptly, a patient’s life can be saved. Any long-term impacts, such as stunting or cognitive development issues, can be mitigated or prevented. The child’s development is put back on track.

What potential side effects or risks come with this treatment?

There are no side effects or risks with this treatment.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Care for malnutrition without severe complications is available in district health centers, which is where most children are treated. When complications arise, adequate treatment is only available in hospitals. Patients are usually referred to the hospital by a community health team. They generally travel from 20 to 50 kilometers away and arrive by either walking or traveling on a hired motorcycle.

What are the alternatives to this treatment?

There are no alternative medications to treat acute, complicated malnutrition. Alternative hospitals are more than two-hour drive away.