OTEIN-CALORIE MALNUTRITION IN UGANDA By J. 5 o ~TEIN ...

'·

06 ., I I , .: "' l·

'/

•'

T AFRICAN MEDICAL JOURNAL . 39 No. 7 July 1962

OTEIN-CALORIE MALNUTRITION IN UGANDA . IV-BUGISU DISTRICT

~ By H. J. L. Burgess, M.B., CH.B. , D.T.M. & H. Nutrition Officer, Ministry of Health Uganda Government, Entebbe, Uganda

~TEIN-CALORIE ' MALNUTRITION IN UGANDA 5 o . IV-Bugisu District /" ' 1 , [jY H. J. L. BURGESS :: . ·: .

' IN BuGrsu ' the scheme for the collection of informati~n ~a~ i~itiated by Dr. W. G. Timni.i~ in mid-March, 1960 and was run by him until he wem on leave in September, 1960. The Medical Officer (Nutrition) then supervised the scheme until it finished at the end of March, 1961.

Medical Units Bugisu is served by one Government Hospital at Mbale, 11 Government

Dispensaries and four Mission combined Dispensaries and Maternity Units. Only four ofthe Government Dispensaries r"d.Medical Assistants in charge; I

the remainder were run by Nursing Orde1 es and many were little more · than aid posts. Mbale Hospital bad about 145 general beds. Accommodation for in-patients at the Government Dispensaries was unequal. Budadiri and Bubulo bad about 45 general beds each, Bukigai bad 16 and Muyembe four. Of the remaining Dispensaries that were run by Orderlies only Bukwa bad beds and that one only four. All the Mission units except that at Budadiri bad general beds, ranging in number from 44 at Magale to 18 at Sipi.

METHOD

It was originally intended to include in the scheme all the Medical Units in Bugisu, but for various reasons only the four Government Dispensaries that bad Medical Assistants in charge could be used. The results did not, therefore, cover the whole district. A further complication was that until thc last three months of the survey dried skimmed milk was only available at · Mbale Hospital, as supplies were then insufficient to allow for supplies being sent to Dispensaries. The only way in which malnourished children attending as out-patients could be dealt with was by advice and by the treatment of associated conditions such as infections.

Comments on the individual Dispensaries may serve to illustrate the difficulties.

Budadiri Dispensary The Medical Assistant here frankly stated that he often failed to completc

forms for cases of malnutrition because the pressure of other work was so great. He saw 13,624 children during the period of the survey and bad 44 in-patient beds to look after. In September the posting of a new Medical. Assistant to the Dispensary coincided with Dr. Timmis's departure on leavc and no forms were filled in for several weeks. ·

Bubulo Dispcnsary Despite the large number of children he saw (11,616) the Medical Assist­

ant obviously tried hard to complete the survey forms. In August, September

,..,.-...;s ~

f

THE EAST AFRICAN MEDICAL JOURNAL 387

.:i.! Ocrober 1960 there was a sudden decrease in the nurober of forms filled ;:: ,rhich was not matched by the returns given for malnutrition on Medical ! >rm i7. The Medical Assistant was certain that the decrease in recognizable _ _, , ~.,was genuine and that mainly undernourished, rather than malnourished, . ':.:j rw had been seen. No reason for the decrease could be found.

;::.i.·:·~..:i Dispensary !)uring patt of September and October this Dispensary had no survey

i;·~~i' kft. The nurober of cases of malnutrition seen during this period was , :·:Jincd from the out-patient records, but many of the details required for thc ;urvey were lacking.

Tbc sudden lapse at both Bubulo and Bukigai was probably connected .:: ·~ ;th thc departure of Dr. Timmis. The Medical Assistants may not have ~i :d :z·:d that the scheme would be continued after he left.

~;· .1,::.~\'onbe Dispensary \"l'fy few cases ofmalnutrition were recorded at this Dispensary. How the

.'.k Jical Assistant managed to see 8,461 children during the period of the ~

,~r.-ry is uncertain. At every visit of the Nutrition Officer the Dispensary

I I

I

! I

•· "' Jcscrted or had only two or three people waiting, whatever the time of

RESULTS

The results from the four Dispensaries are given below.

T:-~..:1 irzcidence During the survey period from April, 1960 to March, 1961 245 cases of

::.l!nutrition were recorded, of which 190 cases (78 per cent) were diagnosed · l ' kwashiorkor and 55 cases (22 per cent) as marasmus.

The 245 children were 0.54 per cent of the total nurober of children t:~Jcr six years old attending the four Dispensaries.

Table 1 Gases of Malnutrition Seen at Dispensaries in Bugisu

f rom April, 1960 to March, 1961

Dispensary •

I Budadiri I Bubulo Bukigai J Muyembe I

r.•ul number of i .~l ildr.:n undcr six I Yt"J fS old attending I Dispcnsary 11,616 13,629 11,553

I 8,461

.'olulnourished children Kwashiorkor 72 35 73 10 Marasmus 34 5 16 -

Total 106 40 89 10

I I

Total

45,259

190 55

245 I I I :-.: ~1r:1bcr of mal-I 1 :h•urishcd children/

1.000 children under

I six ycars old 9 3 8 1

!'\umbcr of cases of malnutrition shown on Mcdical Form 77 360 114 130 19 623

96:.

,.,, __ - ~· _ ..... ·-"""-·-·--""" ... .'~ ~.-,,._... - -·. ... .-.. ......

i''' ;;)<. . , -· .... ,

Tablc 2

Gases of Malnutrition Sun at Dispenraries in Bugiw Each l>fonth from April, 1960 to March, 1961

1961 1960

~------------------~ ]an. I Feb. M arch April ' May June ]uly I Aug. Sept. I Oct. I N ou. I Dec. I Total

Total number of children undcr si>< years old I I au endingDispensaries ~~~~ 4,027 ~~~~~~~ 45,259

Ma/nourislzed children I I K washiorkor 24 18 12 14 28 20 19 13 II 2 11 I 18 190 Marasmus 4 I 5 15 6 3 5 3 2 I 4 6 55

Total 28 I 19 · 17 I 29 34 . 23 I 24 16 I 13 3 15 24 245

Number of malnourished childrcn/1,000 childrcn under six ycars old

Numbcr of cases of malnutrition shown on M cdical For!n 77

715 1 418191416 1 5i 411 ; 5; 7

40 I 26 I 66 I 76 I 50 I 41 I 79 I 47 · I 67 I 35 I 42 I 54 I 623

<.» 00 00

>i

= 1:1!

t!l > "' >i

> ",

" ,.. n > z ::: t!l 0 ,.. n > t"' .... 0 c: :ll z > I"'

~ q-

--.~

1 . , /.~ti:! THE EAST AFRICAN MEDICAL JOURNAL 389 --------------------------~---------------------

= Thc numbers of cases seen at the four Dispensaries are shown in Table 1. .\< 1\ubulo the ratio of kwashiorkor to marasmus was 72:34 (2.1) but at ,-.. . h of the other three Dispensaries it was much higher and in the three . . •:nbincd, 118:21 (6.6).

Table 2 shows the numbers of cases seen in each month of the survey .... ;,\ur. In the period from August to November the numbers were somewhat ~1'<'~i:illct than at other times. More of the foods that are fairly rieb in protein

1rc available in this period than in the rest ofthe year. The Medical Assistants ~JiJ that April and May were months when food was usually short and the numbcrs of cases seen in those months were high.

r

Thc cxact date of birth of 74 children was known. Of the 53 cases of 1;\\ashiorkor, 21 (40 per cent) werein children up to 12 months old, a fairly h:gh proportion. Of the 21 cases of marasmus, 12 (60 per cent) were in this . ;c group. At Bubulo and Budadiri there were more malnourished boys 1!1an girls: at Bukigai and Muyembe the reverse. The significance of the .!::Tcrcncc is doubtful.

Only 15 children reattended, possibly because very little dried skimmed :niik was available at the Dispensaries for out-patient distribution during :n~>t of the survey year. Only one child, who returned two months after her !iN \'isit, was found to be improved.

Twcnry-three ofthe children seen at Bubulo, 20 ofthose seen at Budadiri 1:-:J nine of those seen at Bukigai were admitted for treatment. They were, it ~ccms, given the greater part of the skimmed milk powder that was •vailable, but the in-patient records were not sufficiently full for useful lr.aiysis.

1961

1960

Table 3

Malnourished Children Admitted to Mbale Hospital for 'Treatment from April, 1960 to March, 1961

Gases of malnutrition admiued

Kwashiorkor I Marasmus Total

January 3 2 5 February 3 2 5 March 9 4 13

April 14 23 37 May 14 16 30 June 19 24 43 July 25 8 33 August 16 8 24 September 12 5 17 October 9 5 14 November 5 5 December 5 5 ", Total 134 97 231

.. 390 THI! I!AST AFRICAN MI!DICAL JOURNAL July 1962

Table 4 Results of Treatment of In-patients at Mbale Hospital

I I

Period of stay (days) I I Condition on discharge Total i 1 or 2 3 or 4 5 or 6 7 to 14 Over 14 ! I

Improved 16 30 41 61 10 158 i

Not improved 0 0 2 3 0 5 i

Died 9 2 0 0 0 11 (5%) i Ran away or pre-

maturely discharged

I I i

on request 20 10 9 16 2 57 I !

Admission of malnourished children to Mbale Hospital Data could be obtained for the malnourished children admitted to Mbale

· Hospital for treatment, but not for those seen as out-patients. The admissiom in each month of the year of the survey are summarized in Table 3. The !arge total~ for April, May and J une may have been related to the shortage of food, but were more likely to have been due to other factors, such as the availability of beds or a particular doctor's preference for the diagnosis of kwashiorkor as the principal reason for admission.

As shown in Table 4, nearly half the children stayed in the hospital for more than a week. Only 11 died, but it is probable that many others died amongst the 57 who ran away or requested early discharge.

The distribution of cases of mulnutrition in Bugisu As the whole district was not covered, no useful information could be

obtained about variations in incidence in different parts. The incidence at the Dispensaries at Bubulo and Bukigai, on the south side of Mount Elgon, was higher than at the Dispensaries at Muyembe and Budadiri, on the north side, and the returns fo~; malnutrition made on the Medical Form 77 showed a similar trend.

In the immediate vicinity of Muyembe, cereals (and cotton) are the chief crops. Thefew cases seen there (all ofkwashiorkor) came from the mountain area, where cooking bananas are grown. The bananas are probably of greater importance than cereals in the areas around the other Dispensaries .

. ;;;·