GULU UNIVERSITY MEDICAL JOURNAL

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Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. Table III FEEDING COST for 100 CHILDREN EVERY DAY EUROS One Day One One Year Table III Month FEEDING F75 Milk COST for 9,96 100 CHILDREN 299 EVERY DAY 3588 F100 Milk 79,95 EUROS 2398 28782 TOTAL MILK One 89,91 Day 2697 One One 32370 Year Month NUTRICAM F75 Milk F100 Milk 7,35 9,96 79,95 220 299 2398 2648 3588 28782 TOTAL Cost Rate MILK Nutricam/Milk 89,91 2697 % 32370 8,18 NUTRICAM 7,35 220 2648 Cost Rate Nutricam/Milk % 8,18 Table IV: Outcome at the Nutritional Unit over time Year % Cured % Dead % Defaulters (SE) (SE) (SE) 2002 59.6 (3.7) 17.0 (1.2) Table 2003 IV: Outcome at 78.7 the Nutritional (1.7) Unit over 10.2 time (0.9) Year 2004 % 83.5 Cured (2.0) 9.2 % Dead (1.5) ANOVA* F=21.2 (SE) P < 0.0001 F=12.5 (SE) P < 0.0001 SE, standard 2002 error; F, variance 59.6 (3.7) ratio 17.0 (1.2) *Analysis 2003 of variance 78.7 (1.7) 10.2 (0.9) 2004 83.5 (2.0) 9.2 (1.5) 18.2 (2.1) 10.5 (1.3) % 3.7 Defaulters (1.2) F=10.9 (SE) P < 0.0001 18.2 (2.1) 10.5 (1.3) 3.7 (1.2) ANOVA* F=21.2 P < 0.0001 F=12.5 P < 0.0001 F=10.9 P < 0.0001 SE, standard error; F, variance ratio *Analysis of variance References 1. 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 25 2. Greco L, Balungi J, Amono K, Iriso R, Corrado B Effect of a Low-Cost Food on the Recovery and Death Rate of Malnourished Children J Ped Gastr Nutr 43:512-517, 2006 3. Low-cost, local food supplement improves efficacy of treatment for malnourishment Nature Clinical Practice gastroenterology & hepatology Jan 2007 Vol 4:1 www.nature.com/clinicalpractice/gasthep 25 Gulu University Medical Students’ Association (GUMSA) Passion for life 24
Gulu University Medical Journal (GUMJ) 2009/2010 Vol 5. A Social Medicine Approach To Malnutrition A seven-month-old boy presents to Lacor Hospital in northern Uganda with a four day history of diarrhea. His abdomen is swollen, and he is diffusely edematous. His hair is thin with a reddish tinge. His mother weaned him from the breast several months ago because she was pregnant again, and he has never eaten much since then. His diet consists primarily of millet meal and fruit. His parents are peasant farmers with 5 other children. They returned from living in an IDP camp one year ago. The diagnosis of kwashiorkor is relatively straightforward for this child. He has many of the classic signs of protein deficiency: thin discolored hair, diffuse edema, abdominal distension. The treatment is also uncomplicated: replenishment of the deficient nutrients. What is less straightforward, but just as critical for understanding his current state of health is the social context in which he and his family live—the many layers of disadvantage and structural violence under which they struggle to survive. Social medicine is an approach that calls the clinician to investigate, understand, and address these many levels of social context that lead to their patients’ illnesses, deter treatment, and preclude recovery. The scope of these factors extends from international politics to family context. In the case of the child presented above, the fact that he is the youngest of six children may mean that his parents need to stretch what little food they have between many mouths. He was weaned before the recommended 6 month point because his mother was pregnant again. While one can continue to breastfeed while pregnant, his mother held a belief that this was harmful to the fetus. She was pregnant again because she and her husband did not have access to contraception, despite their desire to not have another child at this time. The family struggles financially because their only means of income is selling their harvest in the market, but this season produced a smaller harvest than expected. The price of the food that they buy in the market has been going up because of inflating world food prices, a reflection of a global food shortage, international Laura Janneck, MBChB IV Case Western Reserve University School of Medicine tariffs, and a variety of other trade agreements. His family lived in an IDP camp where they lived in fear of abductions, attacks, and violence until shortly before the child was born. While there, the family depended on World Food Programme (WFP) handouts, which ended when they returned to their farm and they were expected to be self-sufficient with what they could grow and sell. As these examples demonstrate, a social medicine approach elucidates a variety of factors that impose upon a person’s susceptibility to disease and the course of their illness. When applied to several patients, or an entire population, it can point to public health and policy interventions that can address the roots of disease and prevent future cases. In the case of malnutrition, for example, the WFP is aware that by importing large amounts of food into a region for free distribution, they not only provide food for people that may have no other source of nourishment, they also depress local food prices. The WFP tries to minimize these effects by limiting the chances that the food it distributes gets into the marketplace rather than in beneficiaries’ stomachs. It is also quick to pull out as soon as possible to allow for local food producers to take over production and be profitable in local markets. But if this is done too quickly or without attention to individual households’ capacity for food production or acquisition, many people can be left suddenly without a food source. The solutions to public health and policy challenges like this are often not as straightforward or simple as the diagnosis and treatment of malnutrition. But their effects can be more far-reaching and effective in the long run. It is the responsibility of those in the medical profession, in partnership with public health officials and policymakers, to be able to take this approach to health and illness for the sake of our patients and the communities we serve. Gulu University Medical Students’ Association (GUMSA) Passion for life 25
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