GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. References 1. WHO Global Database on Child Growth and Malnutrition www.who.int/nutgrowthdb 2. Pelletier DL, Frongillo EA,. Dirk JR, Schroederj G and Habicht JP. A Methodology for Estimating the Contribution of Malnutrition to Child Mortality in Developing Countries. J Nutr 1994; 124:2106-22. 3. Caufield LE, de Onis M, Blossner M, et al. Undernutrition as an underlying cause of child death associated with diarrhea, pneumonia, malaria and measles. Am J Clin Nutr 2004; 80:193-8 4. Olumese PE, Sodeinde O, Ademowo OG, et al. Protein energy malnutrition and cerebral malaria in Nigerian children. J Trop Pediatr 1997; 43:217-9 5. W.H.O. Management of the child with a serious infection or severe malnutrition. IMCI. WHO/FCH/ CAH/00.1, 2000. www.who.int/child-adolescent-health 6. Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. WHO Press 2005 7. Management of severe malnutrition: a manual for physicians and other senior health workers World Health Organization Geneva 1999 8. Deen Jl, Funk M, Guevara VC, et al. Implementation of WHO guidelines on management of severe malnutrition in hospitals in Africa. Bull World Health Organ 2003; 81: 237-43. 9. Rasinperä H, Savilahti E, Enattah NS et al. A genetic test which can be used to diagnose adult-type hypolactasia in children. Gut. 2004 Nov; 53(11):1571-6. 10. Sabul TK, Basu S, Bhattacharjee P et al Are lactose free feeds necessary in infants after diarrhoea with lactose intolerance ? J. Pediatr Gastroenterol Nutr, 2004 , 39 Suppl : S276 11. Simakachorn N, Tongpenayi Y, Tongtan O et al . Randomized , double blind clinical trial of a lactose-free and lactose-containing formula in dietary management of acute childhood diarrhea. J. Pediatr Gastroenterol Nutr, 2004 , 39 Suppl : S485 12. Penny ME, Brown KH. Lactose feeding during persistent diarrhoea. Acta Paediatr Suppl 1992; 381:133-8 13. Brewster D. Improving quality of care for severe malnutrition. Lancet 2004;363:2088-9 Beaton GH, Ghassemi H. Supplementary feeding programs for young children in developing countries. Am J Clin Nutr 1982; 35: 864-916 14. Brown KH, Dewey K, Allen L. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: WHO, 1998 15. Allen LH, Gillespie SR. What works? A review of the efficacy and effectiveness of nutritional intervention. Manila 2001.United Nation Administrative Committee on Coordination, Sub-Committee on Nutrition (ACC/ SCN) in collaboration with the Asian Development Bank. 16. Maleta K, Kuittinen J, Duggan MB, et al. Supplementary feeding of underweight, stunted Malawian children with a Ready-to-Use-Food. J. Pediatr Gastroenterol Nutr 2004; 38: 152-158. Gulu University Medical Students’ Association (GUMSA) Passion for life 16
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Nutricam: The food that saves! Luigi Greco, M.Sc. (MCH), M.D., D.C.H., PhD (Hon) Department of Pediatrics, University of Naples Federico II and European Laboratory for Food Induced Disease Valentina Fiorito, M.D. Department of Pediatrics, University of Naples Federico II According to WHO recommendations (1), we attempted to find local solutions to improve nutritional rehabilitation in St Mary’s Hospital Nutritional Unit in Lacor (Gulu, Northern Uganda) (2,3). We decided to evaluate the possibility to introduce a new nutritional intervention, to be added to the UNICEF milk, for the following reasons: - results of the nutritional rehabilitation with the UNICEF milk were discouraging - the large amount of lactose and sugar of therapeutic milks might facilitate diarrhoea, malabsorption and fatality - the UNICEF milk, as any other powdered milk, is not available outside the hospital: many children do relapse, because they are poorly fed when the milk is interrupted by the discharge from the hospital - milk feeds are not available and not traditional to the Acholi children of North Uganda Following the observation of the traditional feeding habits of the Acholi people, and a further check of the availability of the food items at the local market, we purchased at the market outside the hospital maize flour, rice, millet, peas and beans, peanuts, small dry fishes, cow’s meat, chicken and vegetable oil. We prepared a thick semi-solid porridge, with a cereal flour base as carbohydrates, proteins (fish, legumes, meats on rotation) and fats (peanut butter and vegetable oil). The porridge was named NUTRICAM that in the local language, Acholi, means “nutritional feed”. A 150-g serving of Nutricam made with 20g flour (65 Cal, 274 J), 10g fish, meat or dry legumes (20 Cal, 84 J), 5g peanut butter (30 Cal, 122 J) and 5g oil (45 Cal,185 J), provides a total of 160 calories (665 J) and 6.3g proteins (Table I). Each child admitted in the Nutrition Unit according the WHO criteria and in the phase of rehabilitation II (1), was offered two 150-g servings of Nutricam each day in addition to the scheduled amount of milk. Table II shows the week rotation of the feeds, in order to provide for different sources of proteins. 100 child/ day/servings are prepared each morning and 100 each afternoon. A single daily feed (two servings) for a child costs about 5,9 cents of Euro. The total monthly cost, including ingredients, fuel and salary for the cook is about 528,000 Ush (264 USA $ and 220 Euros). Table III shows the cost of the milk feeds for the same 100 children and the ratio Nutricam/milk cost. The cost of NUTRICAM is about 8% of the actual cost of UNICEF milk. The porridge can be made at home as follows: (1) Cook two tablespoons of maize flour (or millet or rice) in 1 cup of boiling water; (2) cook for about 15 min then slowly add one tablespoon of powdered fish and a half a tablespoon of peanut butter, stir vigorously until a thick porridge is obtained; (3) add a half a tablespoon of vegetable oil to make the porridge more creamy. The source of protein can be fish, beef, poultry or beans depending on availability. The NUTRICAM feed has been accepted with enthusiasm by the local population and by the children. They completely consumed two servings each day, while not interrupting the milk feed. We could not observe adverse reactions, as vomiting, diarrhoea, food intolerance. To evaluate the mean growth increments before and after the Nutricam intervention, to avoid seasonal effects, we randomly sampled 100 case files dismissed in the months October, November and December in the years 2001, 2002, 2003. For each case we reported the length of stay in the unit and the weight gain reached at discharge. To avoid complications with oedematous children, we have computed for all cases with oedema > 1+, the increment between the lowest weight reached and the weight at discharge. The analysis of 20 weight growth curves of children Gulu University Medical Students’ Association (GUMSA) Passion for life 17
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