Child Malnutrition Eastern Cape South Africa

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CASE STUDY: Child Malnutrition Eastern Cape South ctorsofThembi’sMalnutrition- licensedunderaCreativeCommonsAttribution- ‐ShareAlike3.0Unported(CCBY- ‐SA3.0)http://creativecommons.org/licenses/by- ‐sa/3.0/Copyright d:October20112

CASE STUDY: Child Malnutrition Eastern Cape South nder,SeniorAcademicProgrammeCo- orAcademicprogrammeCo- sendorsementofthiswork.3

CASE STUDY: Child Malnutrition Eastern Cape South Africa4

CASE STUDY: Child Malnutrition Eastern Cape South AfricaContentsOERDescription.3SECTION1- ‐TOPICRATIONALE.6SECTION2- ninSouthAfrica 173.3BackgroundInformationaboutMountFrere ERENCELISTANDADDITIONALREADINGS.255

CASE STUDY: Child Malnutrition Eastern Cape South AfricaSECTION1- orthe1990sforthecontrolofprotein- orders.Thisstrategy,basedonpreviousnutrition- CEF,1990)[http://www.ceecis.org/iodine/01 global/01 pl/01 01 other 1992 ofthiscrisis’(WHODirector- hildrenneedenoughgood- tp://www.unicef.org/nutrition/files/Tracking Progress on Child and Maternal Nutrition EN 110309.pdf]Childrenbetweentheagesof6- nAmerica,andin2004,itwasestimatedthatupto‘ eOnis,Blossner,Borghietal,2004)[http://jama.ama- ‐assn.org/cgi/content/full/291/21/2600]6

CASE STUDY: Child Malnutrition Eastern Cape South AfricaAnorientationtounder- s(UNICEF/WHOJointCommittee,1989).7

CASE STUDY: Child Malnutrition Eastern Cape South AfricaSECTION2- ‐LearningInput2.1SettingandPopulation rica Childrenunder5yearsofage2.2LearningObjectives cificcontext ionshipofchildmalnutritionanditssocialdeterminants lnutritiononchildren alocaleinone’sownworkingcontext EFConceptualFramework8

CASE STUDY: Child Malnutrition Eastern Cape South a) ,considerhowtheconceptrelatestomalnutrition: malnourishedchild malnutrition under- ‐nutrition severeacutemalnutrition severewasting stunting oedema marasmic- ‐kwashiokor electrolytes electrolyteimbalance hypothermia ReSoMal starterformula MillenniumDevelopmentGoals1,2,4,5 MillenniumDevelopmentIndicatorsb) ioninchildren.c) nonchildren.d) ions/severemalnutrition/9789241598163 //www.unicef.org/nutrition/files/Tracking Progress on Child and Maternal Nutrition EN 110309.pdf[Downloaded:20.10.10].9

CASE STUDY: Child Malnutrition Eastern Cape South Africa2.4CaseStudy:Thembi’sMalnutritionThembi, an 18 month old girl, lives with her grandmother in a homestead in the Mount Frere district, about anhour from the Sipetu Hospital by bus. Her grandmother receives a pension of R948 per month (approx 135 in2008), but this supports two other grandchildren and herself. She keeps chickens but cannot grow a vegetablegarden because rain has been erratic and she does not have running water. Thembi’s mother has not managedto access the Child Support Grant* (see Social Security Grants in section 3) as she is not functionally literate andhas struggled to apply for the South African identity document needed to access the grant. Thembi wasbreastfed for one week, but thereafter her mother returned to work as a domestic worker in the city. Although hermother tries to visit once a month, this is made difficult by the cost of transport and taking time off work.For the past few months, Thembi’s grandmother has been feeding Thembi a thin porridge, but in the last twoweeks she has not been eating well. She has become miserable and irritable, and prefers to be left alone, notmoving at all unless her grandmother carries her.On February 8th, grandmother became worried because Thembi’s stomach was distended, and gave her anenema. That night Thembi passed three loose stools and was very restless. She drank the water quickly that hergrandmother gave her and then vomited. On the morning of the 9th February, grandmother took Thembi to thehospital, a journey which cost R20 one way. This involved walking for 20 minutes to reach the bus stop. As shewas in a hurry, she did not manage to prepare porridge for Thembi.Grandmother and Thembi waited for two hours for the bus. By the time they arrived at the hospital it was 11h00and the Outpatient Department was packed with people. Thembi looked weak. She had not had anything to drinkbecause her grandmother was afraid she would vomit on the bus. They waited in the outpatient queue for onehour and then Thembi was seen by the Sister. By this time she was very weak and she was taken to the wardimmediately. There was no porter to escort grandmother to the ward so she did not get there until 13h30.When Thembi was admitted, she was very thin on her shoulders, ribs, upper arms and thighs. Where her skinwas loose, when the Sister pinched her skin and it took 4 seconds to flatten. Her feet were also swollen(oedematous) and a dent remained when the Sister put pressure on her ankle. The skin on her feet was darkand cracked. Her stomach was distended. Her little bit of thin hair had become reddish, and her weight wasfound to be 60% of what it was supposed to be. Her pulse was weak and fast (Ashworth & Burgess, 2003).She was diagnosed with marasmic-kwashiokor (severe wasting and oedema), and dehydration. Because of herweak pulse she was regarded as “in shock”. She was immediately put on an intravenous drip of 15ml for an hourand warmly covered. A Sister stayed with her and monitored her pulse and respiration rate to avoid overload withfluids. In the second hour another 15ml was administered and then replaced with oral rehydration using ReSoMal(10ml per kg per hour) for five hours. Gradually Thembi’s pulse became normal and a starter formula was usedfor three hourly feeds with added potassium and magnesium (Ashworth & Burgess, 2003).Thembi’s grandmother could not stay at the hospital because she had to go home to look after the othergrandchildren. Two weeks later, when she returned, the nurses suggested she take Thembi home. She hadgained weight in the last week, she had no oedema and was eating well. Because the child was still underweight,grandmother was given a packet of instant porridge and milk powder to take home. The nurses instructedgrandmother to give Thembi eggs, vegetables and high-energy food (Ashworth & Burgess, 2003).10

CASE STUDY: Child Malnutrition Eastern Cape South AfricaBy the beginning of April, however, Thembi was back in the ward with the same condition. The nurses shouted atgrandmother saying that she had neglected the child by not feeding her properly.(Illustration:SarahAllderman,2012)11

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