HL: Bending the Malnutrition Curve in Timor-Leste

Dili, Timor-Leste: Justinha Belo Filipe, all of 11 months had to be admitted to the national hospital, Hospital Nacional Guido Valadares (HNGV) in Dili because she was losing weight, dehydrated and with diarrhoea. The doctors treating Justinha diagnosed with severe acute malnutrition (SAM). By the time Justinha left the hospital, she weighed seven kilograms compared to six that she did when she was admitted.
Apolonia Martins Guterres, seven months old wasn’t in as severe condition but doctors at the Community Health Centre (CHC) in Vera Cruz in Dili classified her as having Moderate Acute Malnutrition (MAM). Unlike Justinha, Apolonia could be managed with home based care and regular follow up. . At her first visit to the CHC she weighed 4.5 kilograms and at the time of her next visit, two weeks later, she showed significant weight gain.
Justinha and Apolonia are just two of the many Timorese children who are malnourished. Timor-Leste has one of the highest malnutrition rates in the world.
Timorese children have the highest levels of stunting and wasting in the region, at 50.2% and 11% respectively. Moreover, 37.7% of under-5 children are underweight.
These numbers are changing for better, slowly but steadily, thanks to the young doctors who are receiving the best possible relevant trainings in the country and abroad.
Dr Lidia Nelia Luisa de Olivera —a doctor at the National Hospital in Dili who treated Justinha — along with seven other colleagues from the hospital received a two-week long training on managing malnutrition at International Centre for Diarrhoeal Disease Research in Bangladesh in April 2016. The training was supported by the WHO Country Office for Timor-Leste.
Dr Lidia, after her return from the training trained 15 more of her colleagues at the hospital and different CHCs, which included nurses and midwives too. WHO has been supporting Timor-Leste in this endeavor; specifically on building capacity of health staff on facility-based management of Severe Acute Malnutrition (SAM). In 2016, the MoH established a seven-member Training of Trainers (ToT) panel who were trained with WHO support. This year, the MoH has conducted series of training workshop on SAM for staff working in the national and five regional hospitals in Timor-Leste.
All these trained professionals are now adept at identifying and classifying malnutrition cases, treatment protocols and therapeutic feeding of children with Severe Acute Malnutrition — three of the main interventions in cases of cases of malnutrition. “The benefits and importance of the training is borne out by cases like Justinha that we are now treating more efficiently and without dependence on any kind of support from outside,” says Dr Olivera.
The other significant gain of the training has been to the healthcare system itself. Most of the uncomplicated cases of malnutrition are now being dealt at the CHC level instead of being referred to the National Hospital. “In case of Apolonia, we knew exactly what to do. We followed the protocols based on our clinical observations and diagnosis and followed up with the mother closely. In order to reduce the burden of malnutrition is important that this expertise is percolated all the way down to the primary level so that malnourished children receive care at their nearest health post level instead of having to travel long distances to secondary or tertiary care centres,” says Dr Sheena Jevatiene Dias Veigas, of Vera Cruz CHC.
Notably, Dr Veigas was trained by Dr Olivera after she returned having completed the training in Bangladesh. And thanks to these doctors and their likes, help for children like Justihna and Apolonia is more accessible than it was ever before.
“The challenge of malnutrition in Timor-Leste is undeniably immense but it is not unsolvable. Training like this is a step in that direction. And we are committed as ever to equip healthcare providers in the country with skills that will help improve the health status of the country,” said Dr Rajesh Pandav, WHO Representative to Timor-Leste.

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