A community health worker demonstrates screening for child malnutrition through IMA World Health's MOMENTUM Integrated Health Resilience.

Through the USAID-funded MOMENTUM Integrated Health Resilience project, led by IMA World Health, community health worker Thierry Kasereka demonstrates the use of mid-upper arm circumference (MUAC) tape that is used to screen children for malnutrition

Combatting malnutrition in the DRC: The importance of community health workers

Health workers are not only key partners in health care delivery, but they play a vital role in building the resilience of communities and health systems.

The USAID-funded MOMENTUM Integrated Health Resilience project, led by IMA World Health, works in fragile settings, where health services are inconsistent or hard to access for residents. In such settings, community health workers (CHWs), who often work in their communities for little or even no compensation, can change lives.

In eastern Democratic Republic of the Congo (DRC), in areas where IMA World Health has been active for more than two decades, one mother shared the profound impact of health workers on her family.

“I was shocked when I heard that my son was diagnosed with moderate malnutrition,” said Passy Kwizera when she brought four-year-old Moise in for a nutrition screening at a MOMENTUM Integrated Health Resilience activity. Moise was just one of the children diagnosed with malnutrition that day in Boikene, a community located in the Beni Health Zone of North Kivu province.

A community health worker screens for child malnutrition in the DRC through IMA World Health's MOMENTUM Integrated Health Resilience project.

A community health worker screens Passy Kwizera’s children for malnutrition.

At Moise’s initial screening, his mid-upper arm circumference measured 119 mm, a sign of what is classified as “moderate acute malnutrition.” A MOMENTUM-trained CHW then advised Passy about the types of food that Moise needed to eat to prevent his condition from worsening. “I had to rely on nutrient-rich foods… in order to improve my son’s nutrition and health status,” said Passy, who learned to ensure that Moise was eating a diversified diet. She was taught how to prepare healthy dishes such as “four-star porridge”—a blend of foods containing the micronutrients needed for a child’s proper development.

MOMENTUM Integrated Health Resilience helps the North Kivu Ministry of Health reduce childhood morbidity and mortality due to acute malnutrition by training and mobilizing CHWs to conduct nutrition screenings for children under five at least once every three months. The project works across eight health zones and trains both CHWs and health care workers on key, standardized nutrition topics such as community-based management of acute malnutrition and maternal, infant and young child nutrition. MOMENTUM also provides mid-upper arm circumference (MUAC) measuring tapes and other supplies that CHWs use for their routine screenings. The CHWs refer any cases of acute malnutrition for specialized care, including nutrition counseling for parents whose children are experiencing diet-related health issues.

Thierry Kasereka, a CHW at the Munigi Health Facility in Goma, has seen the positive results firsthand: “Before, the community believed symptoms of malnutrition [to] be a scourge from the devil, and out of desperation, many families would turn to ineffective traditional remedies and prayers. I’ve been trained by MOMENTUM to teach parents and the community how to spot the signs of malnutrition and other diseases early, and to show them how to keep their children healthy.”

Community health worker Thierry Kasereka screens a child for malnutrition through IMA World Health's MOMENTUM Integrated Health Resilience.

Community health worker Thierry Kasereka screens a child for malnutrition.

According to UNICEF, malnutrition is the leading underlying cause of child mortality in the DRC with 160,000 children dying of causes related to malnutrition every year. In 2022, nearly a million children in the DRC suffered from severe acute malnutrition. This difficult situation is the result of a combination of issues such as poor feeding practices, food insecurity, high prevalence of childhood illnesses, limited community access to safe drinking water and the tenuous security situation.

To help mitigate these challenges and build community resilience, MOMENTUM Integrated Health Resilience has trained more than 700 health care providers in North Kivu, including 520 CHWs, health care workers, and local health officials. With project support, CHWs mobilized by the North Kivu Ministry of Health screened 30,077 children (14,572 boys and 15,505 girls) for acute malnutrition in 70 North Kivu communities between October and December 2022.

MOMENTUM is also partnering with health care providers in setting up community nutrition support groups to enable pregnant and lactating women to learn from their peers about proper nutrition and other essential family practices that promote good health for their children and themselves. Mothers participating in these groups will be supplied with, and trained to use, MUAC tapes to support acute malnutrition screening of children under five as well as pregnant and lactating women.

The CHWs trained and equipped by MOMENTUM help to bridge some of the gaps in health resources in project communities, where health care worker turnover is common. They also assist mothers who are trained through the community nutrition support groups to engage with children on nutrition.

Now, I’ve noticed there are fewer children who become too ill before being taken to a health center. By going from mother to mother, home to home, we are empowering more families and reaching more children than ever before. … If you give power to a woman, she can fight effectively against malnutrition.

– Thierry Kasereka, community health worker, MOMENTUM Integrated Health Resilience

Passy Kwizera would agree. Since she first brought her son Moise to be examined by a MOMENTUM-trained CHW, his overall health has improved. Within three weeks of the initial visit, his mid-upper arm circumference went from 119 mm to 138 mm. “Today, my son looks like a healthy and normal child,” Passy said joyfully.

CHWs will continue to monitor Moise’s nutritional status and encourage Passy to pay close attention to him. “I’m happy about the … CHW’s decision to come back to check on Moise’s nutrition status and thankful for my son’s recovery, which would not have been possible without the work of MOMENTUM Integrated Health Resilience staff. Through this project, not only Moise but other children like him have become healthy again,” explained Passy.