What HIFA2015 members say
Meeting information needs to assess and manage child malnutrition
Please find below extracts from messages sent on the HIFA2015 and CHILD2015 email forums. There have been 49 messages on Nutrition from 11 contributors in 6 countries – India, Nigeria, South Africa, UK (5), USA (2), and Zambia. This page will be regularly updated as the topic is discussed further.
1. Understanding information needs
1.1 Information needs reported by healthcare providers
“Most of the information I come across on nutrition and HIV/AIDS is more generalised and is more inclined towards adults. I feel we need to pay more attention and address the nutritional needs of the child as well, in terms of growth, development and their general well being in the context of HIV/AIDS. Could anyone who has materials or information on such please
guide me as to how I can access it.”
Beatrice M. Kawana, Zambia (February 2007)
”Recently I was discussing with colleagues in Eastern Africa, the information needs of these key staff. It became clear that a general complaint was that the books, etc. that we write are TOO LONG. What the busy nurse wants is something to ‘put in the pocket’ as a sort of aide memoire (or as a medical assistant in Malawi once said ‘can be eaten at one meal’). And they would like more flow charts to put on the ward wall for the same purpose.”
Ann Burgess, UK (March 2009)
“I have found a lot of frustration among health care workers with regard to the new [WHO] guidelines [for diagnosis of Severe Acute Malnutrition in infants <6 months] as the weight/height charts span several pages and having a quick easy reference is what they want - more quick look wall charts, or pocket guides. And the question often comes up regarding whether we are accurately diagnosing malnutrition in the young infant with presumptive HIV infection.”
Annie Buchanan, USA (March 2009)
1.2 Information needs inferred through observation of practice
“Unfortunately weight charts are rarely completed satisfactorily enough to show a faltering in growth. A simple low cost alternative is a mid upper arm circumference (MUAC) measurement. This can be used by community members with little training and when literacy levels are low as the tapes coloured green, yellow and red.”
David Morley, UK (February 2008)
“Unfortunately both mothers and health workers consider weighing the child important! Removing the scales might lead to a dramatic fall in attendance.”
David Morley, UK (February 2008)
“We have data from 2002 regarding the frequency and outcome of malnutrition amongst children admitted to the Royal Victoria Hospital, Banjul, The Gambia: http://adc.bmj.com/cgi/reprint/89/2/181
[The abstract concludes: "Severe malnutrition was both under-diagnosed and wrongly diagnosed by nurses trained in the use of the IMCI nutrition algorithm in a clinic setting in The Gambia. These guidelines for health workers and the training materials, particularly with respect to calculation of age, need further development to improve the detection of malnourished children."]
Stephen Allen, UK (July 2008)
1.3 Information needs inferred through assessment of knowledge
I have worked in rural areas in India and know some of the mother-in-laws would not allow their daughter-in-laws to have a full meal when they are pregnant. Mothers are advised not to introduce any solid food to babies until one year otherwise baby would have pot belly. I am sure things must have changed with time.
Rajesh Chaudhary, UK (June 2009)
“Use of a carry card for mother with only the weight centiles helps. Much simpler and mothers understand the weight of the baby has to increase. If more than that is expected it would be overwhelming for mothers. Health workers still miss the point of growth monitoring and fail to see a nutritional problem looming… We are concentrating on teaching all medical and nursing undergraduates on Growth Monitoring. But it is a battle.”
Miriam Adhikari, South Africa (February 2008)
2. Undertaking and publishing research on malnutrition
“I’d be extremely grateful for any inputs from the CHILD2015 group (or other colleagues who you can forward this mail to) on the MAMI (Management of Acute Malnutrition in Infants) project which I’m currently working on. Project aim: To document current practice in the management of acutely (moderate & severe) malnourished infants under six months age, in emergency programmes… Further information: http://www.ennonline.net/research/ “
Marko Kerac, UK (July 2008)
3. Synthesizing knowledge
“I would like to make a plea that, when such guidelines [WHO guidelines for SAM] are agreed, an effort is made to communicate them in suitable format to the front line health workers in Africa and elsewhere - so they can recognise and know what to do (if only to refer) when they see malnourished babies… Is there anything CHILD2015 members can or should do - or are doing? The York meeting [ICHG spring conference] will allow us lucky ones to know more about ‘what to do’. Perhaps the meeting should also identify ways of sharing this information with frontline workers in ways that suit them best.”
Ann Burgess, UK (March 2009)
“I think that flow charts and short pocket books in point format appears to be most attractive to nurses and other paramedics as well as junior doctors. CHILD2015 should find a way of getting us all to come up with flow charts on common conditions/problems (to start with). And I believe that if the charts are many, they could even be compiled into a small pocket book, which will be easier to read and follow than books.”
Emmanuel A. Ameh, Nigeria (March 2009)
4. Making knowledge available
”For those of us with good or even spasmodic access to the internet it is relatively easy, if we have time, to keep abreast of new developments in the health field. But we all know that it is much more difficult for this information to reach the nurse (or equivalent) who is often the main ‘diagnostician’ at dispensary or health centre level.”
Ann Burgess, UK (March 2009)
“The Nutrition Society Interim Professional Body for Nutrition has updated its Information Sheets 1 -4. These are particularly for nutritionists in low-income countries. Sheet 1 lists low-cost print/hard copy newsletters and journals, Sheet 2 sources of low cost print materials, Sheet 3 sources
of CD-ROMs, and Sheet 4 email/ website access to discussion forums, news and publications… http://www.nutritionsociety.org/index.php?q=node/42.20
Ann Burgess, UK (February 2009)
“Any members of the group who are interested, like Jo Barnes, in nutrition might like to know about the ‘pronut-hiv’ email forum. This deals with the nutritional aspects of HIV/AIDS. To join the group or find out more about it, go to www.pronutrition.org
Ann Burgess, UK (October 2006)
“The AED-SATELLIFE Center for Health Information and Technology is pleased to announce the launch of a new and updated gateway on Nutrition, part of the Essential Health Links Gateway… Specifically designed for health professionals in low-income countries: : http://www.healthnet.org/essential-links ”
Lenny Rhine, USA (February 2008)
5. Applying knowledge
“I designed the original growth chart and was instrumental in the concept of growth monitoring spreading world wide. Unfortunately it was many years before I discussed it with colleagues in education. They pointed out that in primary schools in Africa charting is not taught… This is why I believe Growth Monitoring has been an expensive failure when made national. However in the hands of dedicated individuals the weight chart can be incredibly useful. For wide use I advise the mid upper arm circumference.”
David Morley, UK (February 2008)
“One hypothesis/observation is clear: The concept of Growth Monitoring and its implication at village level has failed. Has there been any study in this regard across the Globe? I have also noticed at many anganwadis (places in villages where village level lady worker takes care of children below six years) do not understand Growth Monitoring and Promotion. However they weigh the children and it becomes useless unless it is interpreted and acted upon.”
Sadhu Charan Panda, India (February 2008)
“I wrote a leading article in the Lancet in 1985 that reviewed a study from Gopalan in India on growth monitoring that had rather negative findings. Growth monitoring: intermediate technology or expensive luxury? Lancet 1985; ii: 1337-38″
Tony Waterston, UK: (February 2008)
6. Measuring impact
“It would be great to hear feedback on [the new WHO Child Growth Standards]. In particular:
1) What are your experiences if you have already adopted WHO-GS for identification of severe acute malnutrition?
2) If you are soon adopting new WHO-GS, what plans are you making for likely increase in patient caseload?
3) Your thoughts on the risk/benefit balance of WHO-GS for the infant <6month age group.
Further information:
http://www.ennonline.net/research/mami.aspx
http://www.who.int/childgrowth/en/index.html “
Marko Kerac, UK (March 2009)
“TALC wants to evaluate the use of a CD-ROM on Community Nutrition… If you are a tutor, or know of any tutors, who can participate in this
evaluation, please send the names, postal addresses and, if possible, email addresses to TALC at info@talcuk.org
Ann Burgess, UK (February 2009)
Contributors
Miriam Adhikari is Head of the Department of Paediatrics and Child Health, and Head of Neonatology, at the University of Kwazulu-Natal, Durban, South Africa. Her interests include neonatology, nephrology, medical curriculum development, and training of nursing staff for care of newborn babies.
Stephen Allen is a co-moderator and adviser for the CHILD2015 email discussion group. He is a Reader in Paediatrics and Honorary Consultant Paediatrician at the School of Medicine, Swansea University, UK. He is the Overseas Director for Africa for the David Baum International Foundation, and a committee member of the International Child Health Group, in association with the Royal College of Paediatrics and Child Health, UK. He has 4 years experience in Papua New Guinea and 6 years with the Medical Research Council, The Gambia, involved in training, research and clinical paediatrics. He has developed eLearning in international health in partnership with colleagues at the University
College Hospital, Ibadan, Nigeria.
Emmanuel Ameh is Associate Professor & Consultant Paediatric Surgeon, Ahmadu Bello University & Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Professional interests include: Neoonatal surgery, Paediatric surgical oncology, Paediatric trauma, Paediatric urology, Medical education.
Annie Buchanan is a Pediatric Infectious Diseases Fellow at Duke University Medical Center, USA. She recently completed a two year stint working with the Baylor International Pediatric AIDS Initiative, spending her first year in Malawi and her second year in Tanzania. She plans to return to Tanzania in 2009 for HIV-related research. Her professional interests include: pediatric HIV and malnutrition; parasitology and tropical medicine.
Rajesh Chaudhary is a Consultant Paediatrician at East and North Hertfordshire NHS Trust, UK. He is a general Paediatrician with special interests in Epilepsy, Neurodevelopment, Community Paediatrics and Respiratory diseases.
Maureen Duggan is a paediatrician, with a special interest in nutrition, and retired apart from teaching one month yearly a tropical nutrition Module at the University of Sheffield, UK where she was a senior lecturer in paediatrics. She worked in South & North Nigeria (senior house officer, specialist and finally senior lecturer/reader in paediatrics), Kenya (research on energy metabolism in measles), and, after early retirement , Uganda (professor of paediatrics and missionary
volunteer) and Malawi (Professor in Community Health & Child Health).
Beatrice Kawana is a nutritionist/dietitian working for the Zambia National Food and Nutrition Commission, Lusaka. The organization is an advisory wing of the Zambian government on nutrition matters and is a Statutory Board within the Ministry of Health. It also plays a coordinating and supervisory role for organizations dealing with nutrition in the country. Beatrice is currently the National Nutrition and HIV/AIDS coordinator and handles all issues that are related to HIV/AIDS for the Zambia National Food and Nutrition Commission, ensuring that nutrition issues are always included whenever HIV/AIDS is being discussed or being dealt with. Beatrice’s interests are centred on reducing malnutrition (macro and micronutrient deficiencies), growth monitoring and promotion activities, and infant and young child feeding strategies.
Marko Kerac is a medical doctor with the UCL Centre for International Health & Development, UK. Following a long held interest in international health (with short projects in India, Guyana and Serbia whilst still at medical school), he did basic specialist training in paediatrics and went out to Malawi for the first time in 2003, where he worked for a year at College of Medicine, Blantyre as paediatric registrar & lecturer. In 2005, he started a part-time PhD, again based in Malawi and focused on management of acute child malnutrition, returning to UK in June 2008. His current main project is looking at Management of Acute Malnutrition in Infants (MAMI project). His interests include Nutrition (focus on Community-Based Therapeutic Care, CTC), HIV, Social Determinants of Health, Early Child Development, Child Growth, Disability and Geographical Information Systems in Health, and Health Systems Research.
David Morley is President of Teaching-aids At Low Cost, a UK-based non-governmental organisation. He is also Professor Emeritus at the Institute of Child Health, London. He is involved in selecting material for TALC to distribute, and resources for inclusion on TALC free CD-ROMs.
Sadhu Charan Panda is a medical doctor specialising in Social and Preventive Medicine. He has served as medical officer for 11 years in rural Orissa, India, under state health services; he now teaches community medicine in V.S.S. Medical College since 1997. He is editor of the Journal of Community Medicine and Medical Consultant of Jawahar Navodaya Vidyalaya, Member of Rotary, IPHA, IAPSM, IMA, and WAME. His interests include the organisation of health services, health education, research, and teaching.
Lenny Rhine is University Librarian Emeritus at the University of Florida, USA. His interests include: delivery of health information in developing and transitional countries; electronic health information; Internet resources; and training for identifying, filtering and using Internet resources.
Tony Waterston is a consultant paediatrician working mainly in the community in Newcastle upon Tyne, UK. He has experience in Zambia and Zimbabwe and currently runs a teaching programme in Palestine. His academic interests are child poverty and children’s rights.
