COVID-19 makes malnutrition rehabilitation more difficult but not impossible

Written By Gladith Yoabu, Communications Volunteer – ENRICH Project, and Agness John, Senior Communications Officer, World Vision 

Social distancing, staying home and limitations on movement are the new normal for most countries, globally, due to novel coronavirus. The situation poses a great challenge to humanitarian and development workers implementing lifesaving activities that require physical interactions. One of the areas affected includes malnutrition rehabilitation centers, also known as Positive Deviance Hearth (PD Hearth).

In the implementation of malnutrition rehabilitation activities, it has become evident that most beneficiaries are not at ease, when called on to participate in malnutrition rehabilitation sessions.

Elizabeth Michael, a malnutrition rehabilitation centre facilitator and Community Health Workers (CHWs) in Dung’unyi village, Ikungi district, Singida region expressed that, “with fear of contracting the coronavirus, it is not easy to convince mothers whose children have been identified as malnourished to continue with rehabilitation sessions. We are worried it may lead to increased child mortality and low performing children in the future, for the effects of malnutrition if not resolved in children under five years old, are irreparable as adult.”

In the current situation, community health workers and promoters find themselves in challenging times to do their work due to the restrictions imposed by the COVID-19 pandemic. The protection of the needy children and mitigation of the current and future suffering among children due to malnutrition is not easy from a project implementation perspective. But commitment this group of community health workers and promoters for vulnerable children and the well-being of their community pushes them to do what they can, even in such challenging times.

Nutritious food
Nutritious food brought by mothers for learning purposes


Sharing his view on the matter, former Community Health Worker and Malnutrition Rehabilitation Centre facilitator, now Village Chairperson for Dungunyi village, Alex Jingu said that, “it is true that we are facing the greatest tragedy of our time. It is also true that we need to limit movement and stay home. But the health of the malnourished children is of equal importance. World Vision Tanzania through ENRICH Project should continue creating awareness on the coronavirus pandemic’s preventive and control measures. We are grateful that World Vision has supported us by providing face masks, handwashing facilities and sanitation supplies.  For our part, we are continuing with the PD Hearth sessions observant and taking all the precautions against the spread of the coronavirus. We are doing this to help children who are malnourished”.

Facilitated by World Vision staff in Tanzania, malnutrition rehabilitation centers, also known as PD Hearth, is a community-based rehabilitation and behaviour change intervention for families with underweight preschool children. The ‘positive deviance’ approach is used to identify behaviours practiced by the mothers or caretakers of well-nourished children from poor families and to transfer such positive practices to others in the community with malnourished children.

The 'Hearth' or home is the location for the nutrition education and rehabilitation sessions. In 12 days of rehabilitation, mothers learn about childcare, general hygiene, proper infant and young children feeding and health seeking behaviors. It is expected that within 12 days of rehabilitation a child gains at least 100 grams of weight. PD Hearth Facilitators and Community Health Workers monitor children development after 30 days, 3 months and lastly 6 months where children are expected to completely graduate from malnutrition.

In Singida region, the stunting rate is 29%, the wasting rate is 4.7%, the underweight rate is 11.7% and anaemic rate is 37% (Tanzania Demographic and Health Survey and Malaria Indicator Survey 2015-16), which according to WHO standards this is a public health concern. “In Dung’unyi village, total of 10 children identified as malnourished during village nutrition assessment and growth monitoring. All of them managed to join the malnutrition rehabilitation centre session, four at a time,” explains Elizabeth Michael.

Following general nutrition status of mothers and children in Singida, availability of nutrition dense food while more children are malnourished due to poor food preparation and feeding malnutrition rehabilitation session is inevitable. This is for rehabilitation of children already malnourished through women practical learning, sustaining rehab and behavioral change