Six months have passed, the journey is finally over! You have managed to exclusively breastfeed your baby as recommended by all the health experts and you’re a hero! Now you can rest. Or so you think, until you suddenly realise that you now need to understand your baby’s nutritional needs, now that they may not be exclusively breastfed. What complementary foods should a baby be weaned between the age of 6 months to two years? You may have no idea. This information should have been given during antenatal classes, at worst you can quickly run to “Google”, and type the question exactly the way it is burning in your mind:
You scroll through the responses and slowly notice a new problem. These answers are not particularly helpful for you and your baby living in Abakaliki, Nigeria. “No, Uncle Google, we don’t have blueberries in Abakaliki or Minna, and what are these plums you speak of?” Welcome to the new phase of complementary feeding as a new Nigerian mother.
Complementary feeding means introducing solid or semi solid food to your baby, in addition to breastmilk. It is advised that complementary feeding begins when an infant is six months old because breastmilk alone may no longer be sufficient to meet his or her nutritional needs. The transition from exclusive breastfeeding to complementary feeding typically covers the period from 6–24 months of age, even though breastfeeding may continue to two years of age and beyond. This is a critical period of growth, both physically and mentally. Nutrient deficiencies during this time period result in malnutrition, stunting, wasting and the infant is more prone to a variety of illnesses. These contribute to increased global rates of under nutrition among children under five years of age.
Daunting Nutrition Statistics
Nearly 60 percent of Nigerian children (6–24 months) assessed by the 2018 National Nutrition And Health Survey were not fed the recommended number of times for their age; 65 percent did not get foods from at least four food groups the previous day and only 17 percent of children aged 6–23 months received the minimum acceptable diet. Less than 50 percent of these children were fed with iron-containing foods. As with most health indices, complementary feeding rates vary across Nigeria, with some states in the South West, North West and North East regions needing more work to promote improved child nutrition, according to the 2018 National Nutrition Health Survey.
Meals served during the complementary feeding period should ideally be made from locally sourced, affordable, and nutritious foods. Introducing soft, semi-solid food a little at a time to allow the infant to get accustomed to the flavour and texture of the food. The infant is fed frequently every day and, as he or she grows, the portion sizes increases.
For Felicity Osiemuwa, a 30-year old working mother, when her son rejected the foreign store-bought baby foods she gave him because he did not like them, she began trying to find foods closer to the local alternatives for her exclusively breastfed baby. The challenge of finding the right food that offered her convenience for her baby who she termed a fussy eater was made a lot easier when she discovered the AugustSecrets’ range of baby foods.
An African Solution
Inspired by another ‘fussy eater’, AugustSecrets is a unique child nutrition company that makes food items using natural cereals and recipes for children using healthy, organic African foods. According to Mrs Toyin Onigbanjo, founder and Head Cook at AugustSecrets, the drive to create healthy nutritious meals for children was borne out of the desperation of having limited food options for her son Jaden, who simply refused to eat store-bought foods. “He just wouldn’t eat the foreign, store-bought stuff and at a point I just got angry and said, is it that there is no single Nigerian or African made baby food? Must my child eat something that was made in Australia or the UK? There were just no baby foods of African or Nigerian origins on the shelf!” she said.
Realising that many families did not understand their options beyond force-feeding their children store-bought imported baby food, and were ignoring the many fresh food options available in Nigeria, Toyin delved into professional nutrition. She started to mass-produce baby foods made from locally sourced nutritious foods including sweet potatoes, yellow corn, peanuts, crayfish, beans and peanuts. From a home kitchen, the company began to gain customers and according to sales records is now stocked in 72 stores, reaching over 35,000 children across Nigeria and Africa, she said.
Despite the fact that the baby food market in Nigeria is expected to reach over N200 billion by 2023, malnutrition is the cause of death of over 45% of children under the age of five, and this challenge is not just restricted to the poorest families. For Toyin and AugustSecrets, realising that the fight against malnutrition required a broader scope than what their for-profit organisation could do, they developed a community engagement arm, Saving 10k.
Saving 10k is funded by proceeds from the sales of AugustSecrets infant and children’s cereals and aims to save 10,000 children’s lives every year from malnutrition by providing information and training programmes in various communities. Started in 2017, it has conducted training in some communities of Lagos State including Makoko and Ajegunle and trained up to 500 women using live food demonstrations. Interestingly, to avoid a conflict of interest, the organisation’s policy bars them from using AugustSecrets foods for the community live demonstrations. Instead, everyday foods common to that community are used, making it more contextual for those attending. This approach could be more widely adopted by private sector businesses as part of their corporate social responsibility interventions.
Beyond the Business
Onigbanjo says for her and her team, it is not only about selling products or making a profit, but it is also about reducing malnutrition in Nigeria by empowering community members to look to local foods around them for alternative sources of nutrition for their children. “We go for these food demonstrations with foods like beans, vegetables, sweet potatoes, carrots… basically common foods that the community people can get for as low as N50 — N100,” she says.
There are three basic pillars which serve as the framework for the Saving 10k community programme:
- Breastfeeding and exclusive breastfeeding awareness — to ensure women at the community level understand that breast milk is the best and most nutritious food they can give their children in the first six months through the first 1000 days of the child’s life.
- Infant and young child feeding — to guide women through the process of introducing solid foods to their children and dispel cultural biases around complementary feeding. For Saving 10k, it is not just about going to communities to provide food, it is about showing communities the nutritional ‘rose gardens’ right in their neighbourhoods.
- Empowerment — Saving 10k provides mothers with some capital as a follow up to the Infant and Young Child Feeding training provided. The programme targets women in rural and semi-urban communities who seem most vulnerable.
Looking ahead; improving Infant and Young Child Feeding in Nigeria
The Saving 10K management team realised that not everybody will be able to afford or even reach AugustSecrets foods, yet every mother needs the right information to feed her child with the most nutritious meals available to her. If nutritious foods, especially infant foods, are not readily accessible, using them to tackle malnutrition cannot be sustainable. This is why they believe the focus should be on considering local alternatives.
There are a few challenges, it appears with the Saving 10k programme; it may be difficult to demonstrate the effectiveness of the cash-based empowerment programme in the long run as there is no way to measure if the funds are eventually used to buy more nutritional locally sourced foods. Research studies looking at the effect of cash transfers on child nutritional status have provided mixed findings. Vocational training to provide a sustainable income might be more beneficial for the families in the long run. Including nutrition of pregnant women and mothers as a component in the community training may also be an innovative gamechanger as studies show that the consequences of poor maternal nutritional status are reflected in high child malnutrition and mortality. In addition, men are not currently actively included in the training and live food demonstrations. Targeting and including men, often the traditional decision-makers in the home could inject a fresh vigour in the battle to curb malnutrition in Lagos State, the programme’s focus state. An independent evaluation of the organization’s activities would help demonstrate the effectiveness and add to the body of knowledge around child nutrition in Nigeria.
Discussions around infant and young child feeding practices in Nigeria and other developing countries seem to focus mostly on breastfeeding practices. There does not seem to be as much awareness or discussion on simple indicators of appropriate feeding practices in children 6–23 months of age. There has been limited progress in measuring and improving feeding practices, and constrained improvements in infant and young child nutritional outcomes. The World Health Organization’s ‘Indicators for assessing infant and young child feeding practices’ survey is one helpful tool that can be used by health workers and nutrition trainers to measure appropriate feeding practices. In Nigeria, specific indicators like this should help health workers answer the many questions mothers often have as they enter the new arena of complementary feeding. Hopefully, with continued community engagement, health workers will be able to give a more detailed response to the question of what to feed a six-month-old, other than the usual ‘anything you’re eating’.
As shown in some states such as Kano and Kaduna efforts towards addressing child malnutrition in Nigeria are growing. Perhaps it is now time for scalable components from all such efforts to be unified into Nigeria’s National Strategic Plan of Action For Nutrition rather than remain vertical programs with limited results. Better partnerships between organisations working to reduce malnutrition in Nigeria, public and private is needed to tackle the daunting malnutrition statistics Nigeria faces.
Do you know of any organisations working to reduce malnutrition through IYCF training programs? How can these programs work together to achieve maximum results in Nigeria? Kindly leave your comments below.