NAWEC Nutrition Program
The program started as a small clinic activity in 2016, which was later incorporated into the community health program in June 2020 as part of the program activities.
It is currently implemented by CHWs in the community, the community nurse in health facilities located in the NCHAP catchment area (Bulika health centre II, Mpoma health centre II, Kasenge health centre II and Katoogo health centre IV), as well as at the NAWEC Health Centre III. Nutrition assessment exercises are usually conducted during Young Child Clinic (YCC) days in these facilities, with more emphasis on children under 5 years.
Roles of CHWs in the nutrition program
- Identify malnourished cases in the community during home visits using MUAC tapes and assessment for oedema.
- Refer suspected cases to nearby government health facilities and NAWEC HC III.
- Deliver health education talks about proper nutrition and balanced diet.
- Documentation of malnourished cases in their CHW registers.
- Follow up on progress of children enrolled on nutrition program.
Roles of the community nurse in the program
- Conduct health education talks on good nutrition practices in government health facilities.
- Conduct nutrition assessment of children visiting government health facilities and document in the nutrition register.
- Receive and reassess/confirm malnutrition cases referred by CHWs from the community.
- Enroll identified cases of SAM (severe acute malnutrition) & MAM (moderate acute malnutrition) into OTC (outpatient therapeutic care) using MOH guidelines.
- Identify and refer advanced malnutrition cases to ITC (inpatient therapeutic care) Mwanamugimu- Mulago National Referral Hospital.
- Conduct nutrition home visits in the community.
- Do follow up on children enrolled on nutrition program.
- Discharge recovered cases off the program.
Identification of Cases
Identification of malnutrition is done by the community nurse using anthropometric measurements of weight, height/length, Z- Scores, MUAC, and assessment for oedema.
MUAC. We use the mid upper arm circumference (MUAC) to assess for muscle wasting in children 6 months and above. For children 6 months to 59 months, a value between 11.5 and 12.5cm (yellow) is indicator for MAM, and that less than 11.5cm (red) is indicator for SAM.
We do not take MUAC measurements for children under 6 months.
Height/length & weight. Height is measured while standing for children that can firmly stand, and length when lying for those that cannot stand.
All children’s weight is taken using a paediatric weighing scale and recorded as well as plotted on their child health card.
Weight for height Z- scores. We use the WHO Z- Score chart to compare the weight and height of measured children according to gender and age for clients under 5 years. This helps to gauge whether the child is of a normal weight or has deviated from the standard weight to either wasting or obesity.
BMI. For children 5 years and above, we compute the body to mass index using the weight in kilograms divided by the height in square metres. The outcome is compared with the reading on the Z- score card, which indicates a normal or deviant weight for height.
Oedema. Children are assessed for presence of oedema by applying thumb pressure on both feet for 3-5 seconds. If a depression from thumb pressure remains for more than 30 seconds the oedema is graded 3 and we refer that child for admission into ITC.
