Plumpy'Nut, Measles and more

By now I may have said all anyone wants to know about the Ilula Nutrition Project.  Regardless, I am posting the description below.  I don't know if anything has happened yet, but I will in a short week!

Will Amundson, MS4, was impressed with seeing a case of measles.  Kelsey Watt and I saw a case last year too.

This is from the WHO Fact Sheet on Measles:

Key facts

• Measles is one of the leading causes of death among young children even though a safe and cost-effective vaccine is available.
• In 2008, there were 164 000 measles deaths globally – nearly 450 deaths every day or 18 deaths every hour.
• More than 95% of measles deaths occur in low-income countries with weak health infrastructures.
• Measles vaccination resulted in a 78% drop in measles deaths between 2000 and 2008 worldwide.
• In 2010, about 85% of the world's children received one dose of measles vaccine by their first birthday through routine health services – up from 72% in 2000.

We don't think twice about measles, but it is still a killer!

Ilula Nutrition Project

Purpose: Improve the nutrition of hospitalized children, especially non-nursing children between the ages of 6 months and 3 years to reduce the risk of irreversible effects that occur in the first “1000 days.”  (Secondary emphasis on children up to five years and nursing mothers.  Tertiary emphasis on all other hospitalized persons.)

Background:  About 38% of children in Tanzania are nutritionally deficient; Illness causes added nutritional stress, thus all hospitalized children need nutritional support.  Because families provide the food to their hospitalized loved ones, nutritional stress is maintained.  Other challenges include hospital supply chain issues such as availability of supplements including vitamins and minerals, even when appropriately ordered by medical staff.  Ready to use therapeutic food (RUTF), such as Plumpy’Nut and Lishe Bora (nutritional porridge) are available.  Plumpy’Nut is available in Dar es Salaam and Lishe Bora is available in Iringa.

Pilot Program for IDH

Protocol:

According to published standards, nutrtionally support all children between the ages of 6 months and 3 years admitted to IDH with Plumpy’Nut during their hospital stay (discharge with their partially consumed packages).  Teach mothers how to use commercial Lishe Bora and how to make their own nutritional porridge.

Inclusion criteria:

1)               All non-nursing and partially nursing children 6 months to age 3 years

2)               Any child over age 3 demonstrating signs of nutritional deficiency, especially with signs of wasting, stunting, or edema.

3)               Others as recommended by evaluating staff.

Step 1:  Feed Plumpy’Nut during hospital stay, according to inclusion criteria, no doctor order necessary.  (Address necessary changes to hospital bylaws or regulations so this can happen.)  Dispense unused (open) portions of Plumpy’Nut with patient at discharge.

Baseline measurements: Wt., Ht., MUAC (Mid Upper Arm Circumference), OFC.

Step 2:  Teach care-giver (mother) preparation of Lishe Bora (nutritional porridge) for use after discharge.  This needs to be developed on site with nursing staff and taught by nursing staff to patient’s care-givers in Swahili. 

Step 3: Follow-up.  Periodic visits to monitor progress every two weeks for 6 weeks, then monthly for three months with Wt., Ht., MUAC and OFC.  Review Lishe Bora with care-giver (teach-back).