Improving accessibility and quality of nutrition and health care in Kamuli district, Uganda

Uganda ranks 149/191 countries for its health system and 19 th for child mortality under age 5. While infrastructure and government policies influence these rates, community education and public health nutrition efforts can improve nutrition and reduce disease burden. The Center for Sustainable Rural Livelihoods (CSRL) at Iowa State University is implementing a livelihoods program in rural villages of the Kamuli district of Uganda. CSRL's Nutrition Education Program (NEC) partners with the Ministry of Health through local clinics and the district hospital. The community‐based NECs target women of reproductive age and children 0–5 years of age. The goals of the program are to provide nutrition counseling and supplementation to pregnant and lactating mothers, address malnutrition among children under 5, and improve access to health and nutrition services through increased awareness and referrals. Each of the 8 NECs provide a supplementary meal, nutrition education, supplementary health services, and crop production services to increase dietary diversification. On entry women receive a seed package for a home garden and are encouraged to serve these crops to their children. At the NEC, the women and their target child under 5 are fed a nutrient dense porridge that contains 456 kcal, 18 grams of protein and 0.9 grams of crude fat per 100 grams. Each child is observed to consume 750 grams of the porridge five days per week at the NEC. The total cost of the porridge per day is 18 cents per child per day. WHO set criteria is used to enroll moderate to severe acute malnourished (SAM) children. Local health clinics or health workers in the community refer new pregnant mothers, while lactating mothers continue until their child improves his/her growth status classification or up until age 5. Community trainers manage the centers and recruitment. Nursing and medical staff from the Health centers provide nutrition, health training, growth monitoring and promotion, prenatal and ante natal care, immunizations, HIV/AIDs counseling and testing, family planning services and first line treatment for common infections. Children with SAM are managed at the local clinics or the Kamuli district hospital before referred back to the NECs once stabilized. By August 2015, there were eight NECs with 1039 enrolled clients, with only 91 (8.9 %) of the clients having defaulted (failed to attend for more than three weeks) and 8 (0.78%) reported deaths. The average monthly weight gain per child is 1000 grams. To date, 336 mothers had planted and harvested nutrient dense staple crops such as grain amaranth and are ready for transition off the program. In 2014, a second CSRL project for poultry production by mothers began. The purpose was to increase animal source protein supply in the community and create income for other food purchases by the NEC participants. Twelve mothers are raising 793 birds that have produced 33,365 eggs with families consuming 5% of the eggs and 28% of the total egg income used by families. CSRL centers have brought nutrition and health services to the communities and the participants have begun to take responsibility for a sustainable future. Support or Funding Information Funding provided by the Center for Sustainable Rural Livelihoods, Iowa State University, 111 Curtiss Hall, Ames, IA 50011