Training health workers in Zambia to identify and treat malnutritionPublished: Jan 29, 2021 Reading time: 4 minutes
In collaboration with the Zambian Ministry of Health, People in Need (PIN) continues its work to help severely malnourished children in Zambia’s Western Province. One recent intervention sought to ensure that local health workers are able to identify and treat malnourished children, and that parents have accurate information about malnutrition.
With funding from UNICEF, the European Union, and UK aid, and under the leadership of the Zambian Ministry of Health, the intervention included multiple trainings on the Integrated Management of Acute Malnutrition (IMAM). Conducted in September and December of 2020, the IMAM trainings, developed by the Zambian Ministry of Health, focused on outpatient therapeutic programmes (OTP) to teach beneficiaries how to manage severe acute malnutrition at home (unlike malnourished children with no appetite or pre-existing conditions, who must be treated in hospitals). Home-based treatment gives health facilities greater capacity for treating severely malnourished children, as this type of treatment requires fewer resources and medical staff, and allows for increased access to timely medical services for more people.
Training for 136 health facilities and 193 health workers
The trainings covered each of the six target districts of the Western Province, and included a total of 136 health facilities and 193 health workers. By the end of the three-day training, participating health workers were able to administer home-based treatment and rehabilitation to moderately and severely malnourished children who had no medical complications.
The trainings had three key goals, which included teaching health workers how to identify malnourished children, how to treat them at home, and how to refer malnourished children with medical complications to facilities with in-patient treatment options.
Kalabo District continues in its commitment to children
The Kalabo District Health Office (DHO) has been working with PIN since 2017, the year PIN began its mission in Zambia, and was the first district where PIN implemented the “Women in Innovation” pilot project. This project focused on grassroots rehabilitation and prevention of moderate malnutrition and saw the DHO, health workers, and community health volunteers working hand in hand.
Upon learning about the new malnutrition project, the Kalabo DHO asked PIN whether the trainings could be expanded to include Kalabo’s local health facilities, so that health workers from three health facilities in the district – Buleya, Winela and Yuka – could also be trained. These health facilities were not initially included in the project due to budgetary restrictions. However, thanks to the District Health Office, their participation was eventually facilitated. After the training, the health workers shared their newfound knowledge with community health volunteers, who were able to conduct mass malnutrition screenings with no additional monetary support from the project.
Having an OTP service supported by community health volunteers is very important for areas such as the Western Province, which is characterised by difficult terrain and weather conditions, as well as long distances between communities. Community health volunteers provide screening and sensitisation in catchment areas, bringing OTP services to remote communities. This allows for earlier identification of malnutrition cases and enables patients without complications to be treated at home, thus minimising caregivers’ expenses for travel and lodging at health facilities.
Buleya steps up the identification of malnourished children
The Buleya Health Centre provides services to 720 households and approximately 820 children under the age of five. The incidence of very young women becoming pregnant in this area is high, and many children are brought up by grandmothers who are subsistence farmers, having limited resources and knowledge to provide nutritious and balanced diet. Therefore, it is critical to monitor the nutritional status of children in this area.
In the last quarter of 2020, the Buleya Health Centre reported a total of 27 cases of severely malnourished children, more than any of the other health facilities in Kalabo that PIN has been monitoring. Previously, there had been no training on IMAM in this district, and only two health facilities had established OTPs, making the identification of malnourished children difficult. Gladys Akalala, a Community Health Assistant from the Buleya Health Centre who participated in the training programme, says she and her staff now know how to identify and treat malnourished children. High numbers of identified children serve as a marker of success; the fact that the Buleya Health Centre has the highest number of identified cases of malnourished children shows that the approach has been working, as in the past, these children would have gone undetected and untreated.
Akalala says: “Thanks to the trainings, the facility is now in a better position to support the community, as we can now identify malnourished children and provide ready-to-use therapeutic food [provided by the project]. The Buleya Health Centre now engages the community in the new programme and streamlines the mass screenings into the general services it already provides.”
Parents have also embraced the programme. “Parents are now bringing their children in for assessments without waiting for the actual planned screening days, because they have seen the benefits from their fellow community members,” says Akalala. “It would be good if all health facilities had OTPs like the one in Buleya, because most of the illnesses in the communities could be defeated by addressing malnutrition.”