GULU UNIVERSITY MEDICAL JOURNAL

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