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Malnutrition Task ForceStructure and Activities for 2006-07Report to IUNS
Structure of the Task ForceThe Task Force comprises i) Governors ii) a Steering Committee, iii) Partnerships and iv) an Advisory Panel.
The Governors are: Members of the Steering Committee are:
Joint Conveners:
Regional focal points: Sub-Saharan Africa: Professor David Sanders, School of Public Health, University of the Western Cape, South Africa Latin America: Dr Ana Maria Aguilar, Instituto de Investigaciones en Salud y Desarrollo Facultad de Medicina Universidad Mayor de San Andres, La Paz, Bolivia. Partner representatitve: Mr Paluku Bahwere, Valid International, UK. (The Steering Committee is expected to expand when sub-regional networks and working groups are established). The role of the Steering Committee is to:
Partnerships will be identified as part of the Task Force activities. Some have already been formed, including WHO, UNICEF, the International Paediatric Association, the Royal College of Paediatrics and Child Health (RCPCH), Valid International, the Regional Centre for Quality of Health Care, and the Latin America Nutrition Network. The Advisory Panel will be broad-based and include all those who can contribute to attainment of the Task Force goals. Activities 2006-07Most activities were related to a) building capacity to prevent and treat malnutrition, b) raising awareness of the importance of malnutrition in child survival, c) case-management guidelines, d) policy and planning. 1. Regional Training on Integrated Management of Severe Malnutrition The Task Force facilitated a joint training by WHO and UNICEF on the Integrated Management of Severe Malnutrition. It was held at Muhimbili University College of Health Sciences, Dar es Salaam, in September 2006. Eight countries from East and Southern Africa were represented: Eritrea, Ethiopia, Kenya, Tanzania, Uganda, Botswana, Namibia and Lesotho. The participants were health practitioners, WHO and UNICEF regional advisors and nutrition officers, and staff from Ministries of Health responsible for planning and implementing programmes to prevent and treat malnutrition. A short report was published (SCN News, Public Health Nutrition, Nutrition Gazette, and Field Exchange). Flora Sibanda-Mulder (UNICEF) and Denise Coitinho (WHO) in their opening addresses described the joint training as a milestone. Not only did it demonstrate the integration of community-based and facility-based care, but WHO, UNICEF, VALID and FANTA worked in partnership and set the example of moving forward together. Botswana subsequently organised a national training. Follow-up in Ethiopia, Malawi and Uganda is in progress through VALID and future roll-out in East Africa is planned in partnership with UNICEF and the Clinton Foundation. Follow-up and roll-out is in progress in Tanzania in partnership with WHO, UNICEF and RCPCH. The aim is to develop at least one centre in each country to lead capacity building activities. 2. Technical Review Committee on Management of Severe Malnutrition Alan Jackson chaired the WHO/UNICEF/IUNS Malnutrition Task Force meeting in Geneva, June 2007 which reviewed particular issues and constraints in managing severely malnourished children in the community and in facilities, and identified actions needed for taking the implementation process forward both at research and operational levels. 3. South/Southeast Asia As part of the Global Review of Nutrition, Tahmeed Ahmed and colleagues from the Asia hub of the Task Force undertook a systematic review of the impact of the WHO guidelines on case-fatality rates of severely malnourished children. The results suggest that the WHO guidelines are sufficiently robust for adequate case-management. They also reviewed the efficacy of ready-to-use therapeutic food and concluded it is a very good option for case-management of severe malnutrition in disaster situations. Feedback was provided to SEARO regarding the Consensus Guidelines for Hospital-based Management of Severe Malnutrition, developed by the Indian Academy of Paediatrics. The guidelines have been published in the Indian Journal of Paediatrics, together with a commentary. In Bangladesh national guidelines for case-management of severe malnutrition have been agreed. Tahmeed Ahmed was keynote speaker at a national workshop convened for this purpose and ICDDR,B facilitated the process of reaching consensus. Public medical schools in Bangladesh do not have functional services for taking care of severely malnourished children. ICDDR,B has recently helped to establish nutrition services in Chittagong and Khulna Medical Colleges. Over a one-year pilot period, at Chittagong the case fatality rate was 10% and the recovery rate was 88%. These services enable a large number of doctors, nurses, and medical and nursing students to receive hands-on training in assessing and treating severely malnourished children. In Nepal a training workshop in Kathmandu was facilitated by members of the Asia hub of the Task Force. The Asia hub is also very active in research on the pathophysiology and treatment of severe malnutrition. Ongoing/recently concluded research includes:
4. Sub-Saharan Africa In South Africa, training and post-training support to improve inpatient management of severe malnutrition is being provided by David Sanders and Thandi Puoane in collaboration with Provincial Departments of Health. Training started in Eastern Cape Province and has been extended to KwaZulu Natal and North West Province. Staff at approximately 250 hospitals have been trained. Operational research indicates that good impact on case-fatality can be achieved if there is sufficient leadership and commitment especially for induction of new staff, on-the-job training and supervision, and resources. The research findings were presented at the National Nutrition Congress as part of advocacy to improve quality of care of severe malnutrition. For the first time, management of severe malnutrition was incorporated into the undergraduate nurses’ curriculum. This was at the School of Nursing, University of the Western Cape. In Southern Africa, the recently appointed Co-ordinator of the Southern Africa Nutrition Capacity Development Initiative (SANCADI), Mrs Joyce Chanetsa, has initiated discussions with Malawi and Botswana regarding their capacity development needs in improving treatment of severe malnutrition. In East Africa, ongoing training and support is being provided to Kilifi district hospital (KEMRI/Wellcome Trust, Kenya) and to Mulago hospital (Uganda), mainly by Alan Jackson and Tahmeed Ahmed in partnership with IAEA. In Sudan, assistance was given to the Ministry of Health by Tahmeed Ahmed in partnership with WHO in preparing national guidelines for management of severe malnutrition. 5. Latin America One of the main events was the joint declaration by Ministries of Health of Bolivia, Colombia, Ecuador, Peru and Venezuela to fight malnutrition and reduce deaths from severe malnutrition. Inter-country activities are planned and the Andean Ministries of Health met in March in Bolivia. In Bolivia, incoming President Evo Morales and Minister of Health Dra Nila Heredia authorized a Zero Malnutrition programme, based mainly on activities carried out through the Task Force by Ana Maria Aguilar. Achievements include:
In Peru, guidelines have been drafted for the integrated management of severe malnutrition. 6. WHO training course on Management of Severe Malnutrition A β-version of the WHO training modules has been developed as a web-based learning opportunity and was displayed at the SCN meeting in Rome. This version is being formally tested by paediatricians and nutritionists with experience in tropical paediatrics and the treatment of malnutrition, before being made available to WHO for general release. This will widen accessibility to the training course materials, in partnership with WHO, and forms the first step in a more consistent approach to web-based availability of relevant training materials. This work has been carried out through a charitable donation from Microlink Inc, who have also provided support for the creation of a website and the secretariat needed to maintain these activities. 7. Collaboration with UK Department of Health and WHO In June 2007, Alan Jackson presented the work of the Task Force to Dr Margaret Chan, Director General of WHO and her team and to the Chief Medical Officer and officials from the UK Department of Health. Possible opportunities for ongoing collaborations were identified. 8. Collaboration with Royal College of Paediatrics and Child Health The incoming President has stated that the College wishes to improve the training of paediatricians in malnutrition treatment both in the UK and internationally. The College will take an active part in helping to develop a centre of better practice in Tanzania, which might develop as a hub for East Africa. Work has started and a intensive programme of nurse training began in April 2007 at Muhimbil National Hospital, Dar es Salaam. 9. Website Work has started on developing a website that will provide a database and information about resources, training, evidence-base for treatment guidelines, review of recent research, answers to frequently asked questions, as well as information about the Task Force and its activities. Links are planned with other sites, such as the RCPCH website. The intention is to have public access, but with the database restricted to e.g. governors and steering committee. 10. Reprint of Waterlow’s classic PEM book Task Force members contributed to the update of specific chapters of the book Protein Energy Malnutrition by JC Waterlow. This book, which was published in 1992, has been out of print for sometime but provides much of the evidence-base for the WHO guidelines for the management of severe malnutrition. The updated version was released in April. 11. Nelson’s Textbook of Pediatrics One of the aims of the Task Force is to see that prominent paediatric texts provide correct information about malnutrition. A new edition of Nelson’s textbook is scheduled this year and input has been provided to the Editors. Input has also been provided to the 4th edition of Nutrition in Pediatrics: Basic science and clinical applications. 12. Funding for 2006-07
From IUNS $ 6,500 13. Reports and publications a) Ashworth A, Khanum S. Improving child survival through improved quality of hospital care of severely malnourished children. Background synopsis prepared for Child Survival Meeting, December 13-14th 2005. b) Jackson AA, Ashworth A, Khanum S. Improving child survival: Malnutrition Task Force and the paediatrician’s responsibility. Arch Dis Child 2006; 91: 706-10. c) Puoane T, Sanders D, Ashworth A, Ngumbela M. Training nurses to save lives of malnourished children. Curationis 2006; 29: 73-8. d) Puoane T, Sanders D. Improving the management of severe malnutrition. Presented at the 21st Biennial Nutrition Congress at the Nutrition Society of South Africa. Port Elizabeth, September 24-27th 2006. e) Ashworth A, Jackson A, Uauy R. The challenge facing the IAP: improving child survival in India. Indian J Paediatr 2007 (July).
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