Malnutrition strikes Jwaneng settlements

A recent visit by The Botswana Gazette news team has revealed a gloomy picture of poor health-care in the poverty stricken settlements near Jwaneng.



Our visit to Sese settlement is welcomed by a little boy that strikes a very small body frame with small eyes sunk in his skull, a ballooned tummy so big you’d feel sorry for the tiny body and legs carrying it. His tummy protrudes from the only cloth on his body, a tattered dirty blue t-shirt which he from time to time puts in his mouth to suck as if it has something sweet in it.
Its afternoon when we meet Koketso Molosiwa*  and his older brother outside a shack they call home in the small village just a stone throw away from the mining town of Jwaneng. Walking into the compound, there is no sense of life apart from the voices that could be heard from the other side of the shack. A middle aged woman meets us and we exchange pleasantries. We would soon learn from our interaction with them that Koketso is one of the many children suffering from malnutrition in the settlement.
We eventually get to the purpose of our visit, where we learn that “Bo nurse ke gone ntse  ba emelela.” According to Molosiwa’s mother, the unexpected visit by nurses was not the first, as they also randomly showed up in 2014 , only to make a follow up visit that day. We ask her what had come to do, “ Ne ba re yo (pointing to Koketso) o na le dibokwana mo maleng. Yo ene yo ( the older brother) ba re ke mo ise cliniking a ye go tlhatlhobiwa mahatha.”
This time around she said the nurses did not say besides informing her to renew medical cards for her sons. Molosiwa also told us that a few weeks ago, “some white   women” came to her house and did tests on her children: the women, we learn, were from Botho Compassion Movement.
Responding to our questionnaire, Botho Compassion Movement revealed that Molosiwa’s sons were not the only ones affected by malnutrition as they were part of a few others who they discovered needed urgent nutritional support.
“Several children were identified as being Severely Acutely Malnourished (SAM), three cases in May 2016 and  6 more in July 2016, and this was just on a short visit and when only screening the children who presented themselves in the yard we were visiting,” Anna Lisa Albers-Mashaba, a medical anthropologist volunteering at Botho Compassion  Movement  said.
According to Albers-Mashaba, a structural assessment of children in the village is yet to be done. She said   SAM noted  cases   were of   children ranging in age from 8 months to 8 years and  that a large number  were seen suffering from Moderately Acute Malnutrition. In addition, she explained that the majority of children seen by the outreach team were border-line malnourished, with a large number of them  suffering from stunting.
“The reason as to why these children are in this condition is both straightforward and very complicated at the same time. The straightforward answer is that they are not getting enough food, and not the right foods (with enough protein, carbohydrates, vitamins and minerals). The more complicated answer is that malnutrition is usually the result of a complex dynamic of social and economic factors,” she said, maintaining, “The families of the children we are talking about are living in poverty, without much hope for a brighter future. They live marginalized lives, their education level and health literacy is relatively low, and their knowledge and ability to access available government services and resources is often lacking .The parents of the families often were raised in a disadvantaged position of poverty themselves. There are issues of poor health, poor knowledge and substance abuse.”
Albers-Mashaba explained that the clinic in Sese was at one point doing direct feeding from its premises, but had to discontinue as parents failed to bring their children daily.   She said early this year  they, together with the Jwaneng Catholic Church Mission  located the disadvantaged families  with children  who  were previously on the direct feeding programmes and  tried to continue the direct feeding with them.
“It proved to be rather difficult to sort out the logistics for this as the families are now dispersed in Sese village and surrounding (informal) settlements such as Dithobane and the Seletsa lands. Because we do not have a car, it was not possible to continue daily direct feeding,” she explained, revealing also that families previously residing in Jwaneng squatter camps were evicted there in December 2015.
“When they were still residing in the squatter camps, Botho Movement and their partners on the ground  were able to provide them every day with cooked meals, which greatly and visibly improved their nutritional status. When the families were evicted the families were sent back to the villages and settlements they originate from,” she said.
According to the volunteer, their movement is working hand in hand with the Ministry of Health  through the District Health Management Team  to conduct a community level screening to identify cases of Severely Acute Malnutrition that need in-patient or out-patient therapeutic feeding.
Meanwhile, Jwaneng Department of Health Management Team (DHMT) Head Malebogo Ranko told this publication that their department is   aware of “sporadic” malnutrition cases in the area. She however reported less cases than  those found by Botho Compassion  Movement, saying  malnutrition in the area was  at moderate of  4.6 % which is three children, while severe malnutrition was  at 1.5% which is one child giving a total of four out of 87 children that they assessed .
She said the area is hit by malnutrition because most of the inhabitants were from Jwaneng squatter areas and had no decent homes to properly care for their children, “… and most of the parents give the children   minimal care because they indulge in alcohol.”
She said the DHMT had since embarked on direct feeding of the malnourished children on daily basis in clinics and daily monitoring of children done by health workers.
The 2015 Global Nutrition Report places Botswana amongst countries with no progress towards meeting World Health Assembly stunting reduction targets by 2015. Of the 114 assessed countries, 39 were  on course, 60 off-course but with some progress, and  15  off course with no progress.  Speaking at the Nutrition Conference held in Gaborone last year, UNICEF representative Vidhya Ganesh stated that, “It is unfortunate Botswana is one of the 15 countries off course and with no progress, and it is the only SADC country in this category. In fact, Botswana is assessed as off course and without progress for all the WHA Nutrition targets.”
She said while  significant progress has been made in ensuring  proper nutrition for children, challenges still  remain throughout the world especially for  Eastern and Southern African countries where stunting, also known as  chronic malnutrition  was  of  concern with more than 25 million, or 40 per cent of children under five years of age suffering from it.  According to Ganesh, globally 161  million children  under the age of five were  stunted, 72 000 of them  in  Botswana.
World Health Organization (WHO) states that malnutrition to refers to under nutrition and over nutrition and that many factors can cause it, most of which relate to poor diet, severe and repeated infections especially in underprivileged populations.  According to World Food Programme, forms of malnutrition depend on the type of nutrients   missing in a diet, how long they miss and at what age. The most basic  it states, is protein and  energy malnutrition, which results from a diet lacking in energy and protein. It cites marasmus to be caused by lack of protein and energy with sufferers looking skeletally thin, with extreme cases leading to kwashiorkor, which causes swelling and a ‘moon face.’
Kwashiorkor is reported to be characterized by bilateral pitting edema  in the lower legs and feet which as it progresses becomes more generalized to the arms, hands and face. Edema, (swelling) is the excessive accumulation of   fluid in body tissues which results from severe nutritional deficiencies. All cases of kwashiorkor are said  to be classified as severe acute malnutrition(SAM ).