ATTENTION!

The blog has now been moved to a new site! All the original posts and some exciting new ones can be found at: www.icsprwanda.wordpress.com .

Hope to see you there! :)

Nyarusange Village, Kamegeri sector

On Wednesday, we went on a field visit to see growth monitoring. Every month, all children under 5 must be weighed and their Mid-Upper Arm Circumference (MUAC) is measured. These are recorded on individual growth charts as well as large WHO growth charts, to see how the village is doing as a whole. In addition, pregnant and lactating mothers with children under two are also assessed by measuring MUAC. These measurements alert mothers and CHWs as to the nutritional state of themselves, as well as their child. The bands and the growth charts have a green, yellow, and red section. If the child is in green, they are healthy. Yellow alerts CHWs that the child is moderately acute malnourished and action should be taken to prevent slipping into severe malnutrition. If the child is in red, he or she is considered severely acute malnourished. This will force the CHW to transfer the child to the health centre for further treatment.

Before the measurements took place, the CHW gave a short community counselling lesson around preventing diarrhoea. The male binome helped to weigh the child and measure their MUAC, while the female recorded the numbers he called out. After each child was measured, the mother put a dot on the growth charts that were hanging up.

One after another, each dot was placed in the green. At one point we saw that a dot was placed in the red and one in yellow.

The child that was in the red was a 14 month old girl, that could not walk or even stand. She had previously been to the hospital, but was throwing up 6 times per day. Due to the child's illness, she could not absorb the nutrients needed for proper growth and development. This can lead to the disease-malnutrition cycle. This means that if a child is malnourished they are more likely to contract diseases as they have a weakened immune system. Alternatively, if the child has an illness they are often not able to absorb nutrients and thus likely to have a reduced nutritional state. Therefore its essential that both the illness and malnutrition are addressed in order for the child to become healthy. 

This village is in the Kigeme Hospital Zone, this means that it is not part of the Nutrition Weeks program. It would be interesting to see if, once this program is implemented district wide, whether these numbers would change.

Karama Village, Masizi Cell

Lesson of the Day: Consistency of Food

CHW leading the Nutrition Week lesson

Pounding small fish into paste to add to the meal

Showing consistency of the thick porridge-
the porridge should be able to stick to the spoon

Mother actively feeding her child thick porridge

Why is proper consistency of porridge important?

• Porridge is good for babies to eat (not to drink!), but it needs to be thick for them to get all the nutrition that they need.
• Eating thicker porridge will help them to fill their small stomachs with nutrient dense food. This will help the child to stay healthy and free from disease.
• If the porridge is too thin, the child will not receive enough nutrients as their stomach will get full on water and flour. 

Recipe used for making thicker porridge:

v  Mix the flour for making local SOSOMA Ex: 10 Spoons of Sorghum flours, 10 Spoons of Maize flours and 4 Spoons of Soya flours is appropriate for 10 children

v  Heat the water until it boils.

v  Mix  the flour (SOSOMA) well  in cold water until the mixture becomes thicker.

v  Put the thicker SOSOMA in boiled water

v  Let it begin to boil and add 2 spoons of Palm oil

v  Continue until the porridge is at least twice as thick

v  Let it cool it and serve the porridge to the children with small spoons  

Kavumu Village Care Group

We traveled to the Kavumu village in the Karambo Cell to visit our first care group. Nine of the ten members were present for their monthly meeting. The chief of the village was also present, and gave us more information about what care groups do.

" Care groups are very important. Members of the group join and work together to make house visits. There are 100 houses in the village. They aim to mobilize hygiene, decrease malaria, and reduce malnutrition. Due to the Care groups, our cell has gone from twelve malnourished kids to four." 

 The chief of the care group leads the lesson for the rest of the members of the group. They then take the information they learned and disseminate it to the village. The lesson that we observed was malaria prevention.

The leader began by greeting all of the members and reviewing the lesson from the previous meeting. Once she began discussing today's topic she began to use the counseling cards provided by the MOH. The card showed three sets of photos. She had members describe what each photo was portraying. The first photo showed a pregnant mother and child sleeping under a mosquito net. The next photo depicted persons cutting down trees in which mosquitoes live as well as getting rid of stagnant water. The last photo portrayed persons killing mosquitoes with pesticides. After each picture, the leader asked "what have you learned from this?". She also asked what you can do in your home to avoid malaria. She did a very good job of reiterating important information and ensuring that all members knew many ways of preventing malaria.

The next portion of the meeting was a demonstration. Members gathered to show how to use a bug net if a proper bed is not used.

Lastly the care group was separated into two and each were given a sign depicting different important messages. They had five minutes to meet as groups and discuss the message behind each picture. After this time was up, everyone reconvened as a large group to present. One sign was a picture of a proper latrine, while the other was proper hand washing using soap.

Following the conclusion of the meeting, we asked about their successes and challenges.

Successes

• Join together and provide moral support
• Give important information to households 
• Persons of the village benefit by seeing the good example that care group members present

Challenges 

• Often get hot and tired as houses are far apart
• It is difficult to change behavior
• There is difficulty getting roofing material for the latrine

Gakangaga Village Testimony

We visited a NW program taking place in the Gakangaga village in the Byimana cell. Again we were welcomed by a lively song and dance. After introductions, a mother approached me, wanting to tell her story.

The mother's name was Uwizaya Pascale, and she has a boy born May 26, 2011. Soon after delivery, Uwizaya fell ill and felt that she no longer had enough breast milk to provide her son. Instead, she began to feed him cow's milk. At four months of age, Uwizaya tried feeding her son watery porridge. At the mandatory monthly weight check at the health center, her son's MUAC and weight/age were both in the red category. At one year of age he weighed 5 kilos.  The health center warned Uwizaya that if she did not get help, her son could die.

Soon after this visit to the health center, Uwizaya attended her first Nutrition Weeks. She learned how to cook a balanced diet. She realized that when her son is sick, she should not only feed porridge, but a more balanced meal.

Now her son is healthy and Uwizaya is very happy with Nutrition Weeks!

Ruronzi Testimonies

At the Ruronzi NW, two attendees were interviewed to learn more about their experiences with the program. The following are paraphrased translations of the conversations.

Betty and son, Eric

Sometimes I find it difficult to feed my child, but if he refuses to eat I make variations. I will change what I make for him from the morning to the evening. I will also sing for him and pray in order for him to eat. 

What I like most about NW is to prepare thick porridge. I learned that the child should not drink it, but should eat it with oil. I also know why to add oil.

Before the program, Eric used to be alone and have no joy. However, after the program, I see that my child is very excited and likes the food. He also sleeps well and does not cry. 

John and daughter, Janet 

Before NW, I was selfish and let my wife do all the work. However now I start to give her money for cooking. I try to help cook thick porridge while my wife prepares the full meal. 

No aspect of the program is that difficult, but I need to help prepare the food everyday to be better at it. Unfortunately, it is hard to find animal sources here. 

I try to teach other fathers during meetings and while gardening. However, some fathers find it hard to give money to their wives, as they rather use it for themselves to buy alcohol. 

After I began to help at home, I find that my wife is much happier! 

 

Ruronzi Village

My first experience of Nutrition Weeks was in the Ruronzi Village, in the Musebeya sector. We were welcomed by mothers and fathers dancing and singing a nutrition song. The CHW leading the program announced the theme of the day to be Balanced Diet.

In order to get the mothers to participate, the CHW asked how to create a balanced diet. Responses included:

 Using a kitchen garden
 Eggs
 Banana plants
 Fish
 Money to buy animal sources

 Before beginning the demonstrations, she also emphasized that mothers must wash their own hands and their child's hands with soap and water before eating and preparing food.


During the lesson, fruit was given to the 10 children while a demonstration of making thick porridge was occurring. The porridge was made by first boiling 10 cups of water. Next 10 spoons of maize flour, and 10 spoons of sorghum flour were mixed with 2 cups of cold water. Husbands were encouraged to watch during the demonstration. One father participated in stirring the porridge and water mixture. This allows the fathers to prepare the food at home. Palm Oil was also added to the porridge.



The meal created demonstrated a balanced diet. It consisted of fermented beans, palm oil, vegetable oil, small fish paste, ground nuts, Irish potatoes, greens, and legumes. The CHWs explained how each of the items correlated to proper health. Beans were considered to be constructing food as they provide protein for growing strong muscles. The oils and nuts were energetic foods. Greens were protective foods, as they would prevent children from contracting diseases. Additionally because the palm oil is red palm oil, it provides the children with Vitamin A. This vitamin helps to prevent blindness and other eye diseases.

When the porridge was passed out, the mothers let the children feed themselves. However after distribution of the balanced meal, the CHWs encouraged mothers to actively feed their children. All of the children seemed to enjoy the food and would not stop eating!


Eating a varied diet is very important, as each food group provides different nutrients. To ensure that children are healthy and free from disease, their meals should include the following:
• Animal-source foods (meat, chicken, fish, liver), and eggs and dairy products: provides iron to prevent anemia, Vitamin D for strong bones, and protein for strong muscles                
• Staples (maize, wheat, rice, millet and sorghum); roots and tubers (cassava, potatoes): provides energy
• Legumes (beans, lentils, peas, groundnuts) and seeds (sesame): provides protein for strong muscles
• Vitamin A-rich fruits and vegetables (mango, papaya, passion fruit, oranges, dark-green leaves, carrots, yellow sweet potato and pumpkin), and other fruit and vegetables (banana, pineapple, watermelon, tomatoes, avocado, eggplant and cabbage): prevents respiratory diseases and helps to protect the eyes

It is also important to continue breastfeeding up to two years of age! 

Cycle III

Hello! 

I see that it has been a year since any updates on World Relief (WR) activities in Rwanda have been posted. I am here to change that. My name is Emily, and I am a recent graduate from the University of British Columbia, who is volunteering with WR for three months. Over the course of my time here, my goal is to document many aspects of Nutrition Weeks so everyone can learn more about this program. I hope you all enjoy the posts to come!