Knowledge and Practices of Village Health Team Members in Early Detection and Care for Children with Severe Acute Malnutrition at the Community Level: A Case Study in Rural Uganda

By Kemigisha, Elizabeth; Atwine, Daniel et al. | Canadian Journal of Public Health, January 1, 2016 | Go to article overview

Knowledge and Practices of Village Health Team Members in Early Detection and Care for Children with Severe Acute Malnutrition at the Community Level: A Case Study in Rural Uganda


Kemigisha, Elizabeth, Atwine, Daniel, Orikiriza, Patrick, Natukunda, Naome, MacDonald, Noni E., Canadian Journal of Public Health


Malnutrition remains a serious problem for young children in many developing countries. In Uganda, high malnutrition rates have been reported in the southwest region where 40% of children have chronic malnutrition, 5% with acute malnutrition. Community-based Village Health Teams (VHTs) with very basic health knowledge provide the first level of government-supported health care. WHO (World Health Organization) recommends community management of malnutrition, but little has been documented on the role of VHTs in this regard. We carried out a survey to compare VHTs in two rural communities in terms of: knowledge in food classification, malnutrition detection using MUAC (mid upper arm circumference) tape, and VHT advice on breastfeeding options for those with HIV. We also documented the challenges faced in community management of malnutrition.

METHODS

We conducted a cross-sectional survey among 124 VHTs (59 in site A and 65 in site B) from two randomly selected rural areas in Southwest Uganda: Mbarara district (Site A) and Bushenyi district (Site B). Site A had VHTs with one-time training at recruitment with no refresher training and Site B VHTs had several trainings through the Healthy Child Uganda/MUSKOKA project. Data collection took place between August 2013 and June 2014.

Both quantitative and qualitative methods were used. A pretested structured questionnaire was administered by trained research assistants. Socio-demographic data, nutritional knowledge of VHTs, training and use of MUAC tapes, and quality of VHT advice on breastfeeding options for those with HIV were collected. A list of 14 local food items was given to the VHTs: 5 body-building (e.g., beans), 7 energy-giving (e.g., potatoes or bananas) and 2 health-protective foods (e.g., fruits or vegetables). A VHT was considered to have adequate nutritional knowledge if they correctly classified more than 50% of the common local foods according to the three main types.

The data from the questionnaires were entered in SPSS v. 20 and analyzed. Chi-square was used to compare the VHT characteristics between sites.

Five focus group discussions were held in the same study period in the two sites, each involving 8-12 mothers and/or fathers with children less than five years of age, to discuss care practices and challenges faced in tackling malnutrition in the community. These discussions were led by trained research assistants, carried out in the local language (Runyankole), recorded, transcribed and translated into English. The principal investigator verified the translation and together with the team identified consensus key themes arising from the discussion through content analysis.

Informed consent was obtained from all the VHT and focus group participants. The project received ethical approval from Mbarara University of Science Technology research ethics committee and funding and support was obtained from MicroResearch. …

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