Malnutrition is a direct or underlying cause of 45% of all deaths of under-five children, and Nigeria has the second highest burden of stunted children in the world, with an estimated 2 million children suffering from severe acute malnutrition (SAM). Only two out of every 10 children affected is currently reached with treatment. Only 17% of babies are exclusively breastfed during their first six months of life, and just 18% of children aged 6–23 months are fed the minimum acceptable diet.
The first 1,000 days of a child’s life offer an exclusive opportunity to prevent undernutrition and its effects. Proper and reliable infant and young child feeding (IYCF) practices have been shown to improve child health and development. Based on the benefits of optimal feeding practices in early childhood, the World Health Organisation and United Nation Children’s Fund (WHO/UNICEF) recommend the initiation of breastfeeding for all new-borns within the first hour of life. They also recommend exclusive breastfeeding (EBF) for the first six months of life, and continued breastfeeding for two years and beyond with nutritionally appropriate and safe complementary foods introduced around the sixth month. Despite substantial improvements in national legislation, health system responses and community level development, IYCF practices in Nigeria still fall below expected levels. Strengthening community and facility-based participation, and broader IYCF policy implementation are needed to enhance current feeding practices.
Alive & Thrive (A&T) is a global nutrition initiative to save lives, prevent illness, and ensure healthy growth of mothers and children. In 2014, A&T began working in Nigeria in the areas of maternal and adolescent nutrition, using agriculture and social protection programs to improve maternal, infant, and young child nutrition (MIYCN).
In November 2017, A&T launched a pilot programme in Chukun Local Government Area (LGA), Kaduna State, to address some of the critical nutrition gaps of mothers and children in the state. Beginning in one ward, the programme gradually scaled up and is now active in 16 LGAs in the state. Their approach is based on evidence that the first 1,000 days of a child’s life is an opportunity to build the foundations of optimum health, growth, and neurodevelopment. A&T employed the support of community influencers, state agencies and other key stakeholders in advocating for better Infant and Young Child Feeding (IYCF) practices among women and their families.
Engaging the Breastfeeding Guardians
The breastfeeding guardians are influential community members engaged by the Nutrition Initiative Programme to serve as champions for the breastfeeding cause in their communities. When the programme first started, the people were resistant to exclusive breastfeeding practices. These guardians were local influencers and were engaged to help the people understand the need for exclusive breastfeeding and including nutritional options during complementary feeding.
Suleiman Ishak, the youth leader of Kaduna North LGA, and Hajiya Nana, a local Councillor, have been working as breastfeeding guardians for 10 months. They noticed that women in their community were not breastfeeding children the proper way. They told A&T about their concerns, andt the role of the Breastfeeding Guardian was born. The job of the guardians in breastfeeding awareness relies strongly on interpersonal communication skills. They gather other influential community members in schools, marketplaces, religious centres and local events to talk to them about what it means to breastfeed, how to go about early initiation, exclusive breastfeeding and complementary feeding.
Additionally, the breastfeeding guardians engage in house to house visitations to demonstrate to nursing mothers how to ensure personal and good hygiene in the home. They teach them to always clean their breasts before feeding the child and discourage mothers from feeding their children with Breast Milk Substitutes (BMS).
Leveraging the State Apparatus
Ramata Musa Haruna is the acting State Nutrition Officer (SNO) of Kaduna State. She testifies that A&T has greatly impacted Infant and Young Child Feeding (IYCF) practices in Kaduna State as a result of their focus on the four components of IYCF: early initiation, exclusive breastfeeding, appropriate complementary feeding and proper hygiene practices.
Chikun LGA of Kaduna State has an estimated population of 268,000 residents. Hajiya Ramata Musa Haruna said that before the introduction of A&T in Chikun, the pilot LGA, the adoption of early initiation of breastfeeding among mothers was 9%. As a result of the work of A&T, the community has now recorded 98% adoption of early initiation of breast feeding as at December 2019. In addition, before A&T, the community recorded only 27% adoption of exclusive breastfeeding, but by December 2019 the adoption rate went up to 78%.
The Kaduna State Emergency Nutrition Action Plan (KADENAP) is a key partner of A&T. It is also a key influencer of policies, collaborating with A&T to influence various nutrition polices in the state. KADENAP is involved in two intervention programmes, Community Management of Acute Malnutrition (CMAM) and Community Infant and Young Child Feeding (CIYCF). The A&T initiative falls under CIYCF. Under CIYCF, KADENAP engages in activities to prevent malnutrition in collaboration with A&T.
KADENAP has collaborated with A&T over the years to increase maternity leave in the state from three months to six months. This allows a nursing mother to breastfeed her child exclusively for six months.
KADENAP holds coordination and review meetings monthly and quarterly to assess their progress on the initiative and re-strategize. The KADENAP Steering Committee (KSC) meeting holds quarterly, while the Technical Working Group (TWG) committee meeting holds monthly. A&T participates in these meetings, which usually have the representatives of the LGAs present. The LGA representatives provide feedback on the progress of the programmes at the respective local governments.
Harnessing the power of Community Influencers
Imam Habib Mohammed from Rigasa, Kaduna State is an IYCF champion. As a leader in the central mosque, he enlightens parents on the importance of proper childcare especially for infants and children between the ages of 6months to 2years. He teaches them to feed children with nutritious foods that complement breast milk, like beans, fish, eggs, banana, soybeans, and liver. These foods help the child to grow healthy and protect the child from common illnesses.
Reverend Sunday Teman Wamare is the Christian Association of Nigeria (CAN) Chairman of Rigasa District. He educates young mothers and fathers on how to feed children who are six months old and above with complementary foods. One of the challenges he has encountered is insecurity in the state. He has not been able to reach areas like Maramawa, Koto and Agwan Kanti due to insecurity.
Karimatu Yusuf, Hajara Abdullahi and Maryam Mohammed are Traditional Birth Attendants (TBAs). They were trained by A&T and provided with technical resources to help create awareness on IYCF. One resource is a book that contains data and pictures of pregnant women, old people, mothers-in-law, young women, and grandparents. On their visits to pregnant women, the TBAs they show them the pictures and explain the roles of each of group in championing better nutrition for their children. The roles of TBAs in childbirth have become more defined as supportive, and they now encourage mothers to give birth in health facilities.
The Facility-based Champions: Providing skilled care
Hauwa Abdullahi is a health worker at the Public Health Clinic in Rigachukun. The clinic has been working with A&T to spread the IYCF programme to communities since 2018. The clinic provides group and individual counselling for parents, grandmothers, fathers and youths of childbearing age. Hauwa educates them on the nutritional content of breastmilk, emphasising that breast milk is 88% percent water and 12% milk.
Victoria Alabi Olajumoke is the Midwife In-Charge of Jowako Specialist Hospital, Kaduna. A&T has been partnering with Jowako to create awareness on complementary feeding and early initiation of breast milk after delivery. During ANC trainings, Victoria and her team of midwives and nurses educate expectant mothers on first steps to take once the child is born and how to deal with the challenges they may face.
Rabiatu Adamu from Rigachikun says she has benefitted from the A&T IYCF interventions. She and her husband receive weekly SMS reminders about best IYCF practices. A&T volunteers visit her home to educate her on nourishing choices of food for her son, Aminu. She says she exclusively breastfed Aminu for the first six months. She then started him on foods like fish, meat, eggs, beans, and other vegetables. Aminu did not have any of the diseases that were rampant among babies in the community.
Umar Abubakar Igabi learnt about the IYCF practices from the teachings of the Imam at the Rigasa central mosque and from health workers. Since the birth of his baby boy, he and his wife have adopted better IYCF practices, including exclusive breastfeeding for the first six months, after which they gradually introduced him to nourishing foods. He said that their baby is healthy and did not suffer any of the illness that his previous children suffered as infants.
A Call to Action
Alive & Thrive’s application of the concept of Social and Behavioural Change through community influencers seems to have greatly improved outcomes of IYCF in Kaduna State. Despite the challenges in traditional beliefs, practices and low literacy levels, infants, children and mothers are being equipped with the proper knowledge to change their poor nutrition practices. This will result in better life outcomes. Alive & Thrive, in collaboration with the Kaduna State Government has recorded success in strengthening community and facility-based participation in better child nutrition. This has led to the establishment of integrated IYCF policy implementations needed to improve the current feeding practices of Nigerian mothers. Without the reception and innovative determination of the Kaduna State Government, the Alive & Thrive intervention would have been near impossible.
To be sure, Alive & Thrive has not reached 100% best nutrition for all the infants, young children and mothers in Kaduna State. There is still more to be done in ensuring no child dies due to poor nutrition and that every woman, man and household makes good nutrition decisions so that every child can have equal opportunities to thrive.
The success of Alive & Thrive in Kaduna State is a lesson in the power of collaboration. Other State governments in Nigeria can learn from the partnership between Alive & Thrive and the Kaduna State government to establish effective and sustainable measures to promote the health and wellbeing of mothers and children in Nigeria.
Do you know of other successful child nutrition interventions in Nigeria? Let us know on our social media platforms, @nighealthwatch on Twitter or @nigeriahealthwatch on Facebook and Instagram.