Story of an adolescent mother whose life changed after Nutrition health sessions at Kakoni Health Outpost By Angella Natukunda, KRC Nutritionist, Kyaka II Refugee Settlement

Nutrition education sessions is a vital part of the routine activities done at Kakoni by KRC in partnership with Save the Children. Its main aim is to promote healthy nutrition behaviour at community level. Education sessions are routinely held in the nutrition shade as clients wait from the screening phase. Topics concerning Maternal Young Child and Adolescent Nutrition (MYCAN) are pre-prepared and taught to all the beneficiaries to equip them with Nutrition and health information so as to change feeding practices.

Approximately 2 kilometres from Kakoni health outpost in the rugged plains of Kakoni zone in Kyaka II refugee settlement is Sikiriza Ombeni, an 18-year-old lactating woman enrolled on the Targeted Supplementary Feeding programme (TSFP) at Kakoni Health Outpost. When Ombeni and her husband (19years) sired their first child through cesarean section at Bujubuli hospital, her life was filled with severe strain because she felt alone. With no elderly guidance on how to feed and nutrition practices for herself and the baby Ombeni fell in cascades of depression. As though the sorrows of her loneliness were not enough, it dawned on her during her post-natal care visit (PNC) that she was moderately acutely malnourished (screened with a MUAC of 21 cm). During this time, she was nursing an engorged and painful breast and it was difficult for her to feed her 2months old child.

She was immediately enrolled on a targeted supplementary feeding program (TSFP) implemented by KRC in partnership with save the children at Kakoni Health Outpost. Ombeni was very distressed with relentless issues; ranging from feelings of abandonment, not knowing how to go about her engorged painful breast, malnutrition, lack of support from her partner that had caused her to withdraw the nurturing practice of breastfeeding her child. Her body often felt weakly and she felt sad, alone and hopeless. One day during her TSFP visit she happened to attend one of the nutrition education sessions on breastfeeding where she presented challenges with one of her breasts that was engorged and painful. So sad, and depressed she constantly carried a feeding bottle with cow’s milk for the child (2months) a discouraged practice and a potential cause of morbidity and malnutrition of the child. The feeding practice of cow’s milk was expensive, unsustainable and not nutritious for the child. In the nutrition shed; as she sat amongst the other clients/care givers she silently listened the nutrition assistant and volunteer highlighted out the benefits of breast milk; as being cheap, nutritious, body protective and discouraged mixed feeding. That feeling of awareness was aroused deeply in her, she wished her first child a good life too and when the nutrition volunteer continued to emphasize that adequate nutrition during infancy and early childhood are mandatory to ensure childhood growth, health and development of the baby she was greatly moved and wanted to breastfeed her child again. After the routine nutrition education sessions, she moved closer to the nutrition volunteer and softly whispered” I need to talk to you; I have an urgent breastfeeding problem”. She was directed to a spot aside the “counselling corner” here the volunteer met her; with tears rolling down her eyes she narrated her experiences after the caesarean section and showed her the engorged breast. The volunteer with the aim to diagnose the cause of engorgement requested her to place the baby on the breast and alas just as she had predicted noticed wrong attachment of the baby onto the breast. Well, the volunteer wore a warm smile encouraged her to be strong for this was to be sorted out soon within a few days if she adhered to the advice given. She was also told to hand express the first milk using warm water gently the engorged breast and continue breast feeding with right positioning and attachment.

A follow up visit was made to her home on the previous actions laid onto her to carry out. With constant home visits and counselling sessions within 3 days the engorged breast has healed and the baby under 6 months was enjoying the benefits of breast milk. Ombeni full of excitement, found courage to put into practice all the nutrition advice she could get at the health centre and at home. As a result of these efforts, her nutrition status improved to MUAC of 22.8cm. Happy Ombeni now teaches mothers around her homestead of the powers of optimal breastfeeding attachment or latching and how it prevents breast engorgement and ensures sufficient drainage of the breast for continued milk supply. During the home visit; Ombeni’s adolescent husband was also taught on ways he could get involved in making sure his household had a good nutrition and health status. This was in terms of providing a balanced diet, setting up a small kitchen garden, to ensure the child doesn’t fall into the mothers’ cycle of malnutrition and constantly attending the PNC and TSFP alongside Ombeni in order to learn more and kick out malnutrition from his household.