children’s ward and nutrition unit
ST. LUKE’S ANGAL HOSPITAL NUTRITION UNIT
The average number of patients of St. Luke’s Angal Hospital Nutrition Unit ranges from 15 to 25. The Nutrition Unit is located near the paediatric ward but in a different building. Nutrition Unit has its own room for the night rest, adequate space for supervised feeding, nurse’s office and duty room, kitchen and store. Medical Officer and Senior Nurse in charge are the same of children’s ward, but among the staff there are three Nursing Assistant specifically committed to Nutrition Unit and the duty roster is organized so that for every morning and evening duty, one Nurse assistant takes care of N.U. No nurses are there during the night, but mother and attendant can easily reach Children’s ward to collect the treatment or to explain major complains. However, unstable patients, during the night are transferred to Children’s ward. Three cooks work in our Nutrition Unit and the senior one has also the responsibility of store keeper.
On admission Nurse Assistant performs the antropometric evaluation (age, body weight, height, MUAC) and Medical Officer the clinical evaluation. As laboratory investigations are routinely requested BS for MPS, stool for parasites, HB. Diagnostic serology is requested according to the clinical conditions and the history. All malnourished children are treated with multivitamins, folic acid, vitamin A (day 1,2,14), antibiotic drugs. According to the clinical conditions, other treatment can be added.
In order to receive therapeutic feeding, children are divided in “initial phase” or “rehabilitation phase” and this is clearly indicated on the medical form with a different colour, to make it easier the distribution of meals. In initial phase children receive an home made F75 formula, cooked following the WHO guidelines. Unfortunately we lack mineral/vitamin solution. In rehabilitation phase children are allowed to gradually introduce some family food like, rice, beans, meat, fish, eggs, fruits.
Meals are distributed five times a day and once at night. Together with the last feeding of the evening mothers or attendants receive a flask to keep warm the therapeutic milk and give it to the child during the night.
Mother are involved in food preparation which is part of their health education. Health educations also consists of lectures with a twice a week calendar (Tuesday and Thursday) in the morning hours.
Lectures are alternatively performed by Cooks, Nurses, Senior Nurse, Medical Officer. Major topics are: malnoutrition, personal hygene, weaning, immunization, acute GE, family planning, HIV/AIDS, intestinal parasitosis, malaria, pneumonia, tetanus, anaemia, disadvantages of local cuts and ebino removal, maternal deprivation, food values, skin lesions.
At discharge children receive supplementary family food for 2 weeks and then they are asked to come back for a follow up visit after 2 weeks. No relapses are been found up to now.
In the second semester of this year 2008, the total number of admission was 85 patients. Up to now the number of children admitted is 25. Improved and so discharged were 34 (56,67%), death cases 26 (43,33%). The average length of stay was 15,33 days. The average weight gain was 0,38 kg, with an average weight gain per day of 7,56 g.
MINI MALNOUTRITION SURVEY
In order to understand the magnitude of the problem of malnoutrition in our setting a mini-survey was done in our outpatients department (OPD) and in Children’s ward.
In OPD patients underweight (low weight for age accordingly to Uganda Clinical Guidelines 2003) is 15,8%, compared with 16,6% of West Nile result as indicated in Uganda Demographic and health Survey 2006 final report data. We founded no severe underweight (very low weight for age).
Wasting (weight/height 70-80% calculated accordingly to Uganda W/H chart) was 7,8%, compared with 8,3% of UDHS 2006. No cases of severe wasting.
In Children admitted to Children`s ward, prevalence of malnoutrition was higher than expected: 28,28% of underweight and 14,14% of severe underweight. Wasting was 24,24% and esvere wasting 6,06%. Complete results and table are shown in Annex 1.