BARRIERS TO EXCLUSIVE BREASTFEEDING AND STRATEGIES TO IMPROVE THE UPTAKE IN THE EAST REGION OF...
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Transcript of BARRIERS TO EXCLUSIVE BREASTFEEDING AND STRATEGIES TO IMPROVE THE UPTAKE IN THE EAST REGION OF...
BARRIERS TO EXCLUSIVE BREASTFEEDING AND STRATEGIES TO IMPROVE THE UPTAKE
IN THE EAST REGION OF CAMEROON
Adidja AMANI, MD MPH Fulbright Alumnus Performance-based Financing Healthworkforce development IYCF specialist, EBF advocate Head of Child Health Service Ministry of Public Health- Cameroon
MAY 2015
Background:
Neonatal mortality in Cameroon accounts for about
50%and26%ofinfantdeathsandchildrespectively
(DHS, 2011) furthermore, neonatal mortality rate
increasedfrom41to29and31deathsper1,000live
birthsin1998,2004and2011respectively.
According to the Lancet Child Survival Series 2003,
breastfeeding is the single largest impact on infant
mortalityofallpreventiveinterventions.TheMinistry
of Public Health of Cameroon recommends that
infants be exclusively breastfed until the age of six
months;however, theexclusivebreastfeedingrate is
very low in Cameroon, 20% (DHS‐MICS 2011),
moreover52%ofbreastfedchildrenreceivedfoodsbeforethestartofbreastfeeding.
Improving the duration of exclusive breastfeeding is a national and international
priority.
AteamfromtheMinistryofPublicHealthwentforatrainingof30healthworkerson
essentialcareofthenewbornswithagreatemphasisonexclusivebreastfeeding.This
was the occasion to gather Information on the perceived barriers to exclusive
breastfeedingandthesolutionstoimprovetheuptake.Theparticipantscamefrom4
healthdistricts:Batouri,Delele,BertouaandKette.
TheObjective
Theobjectiveoftheexercisewastounderstandthebarriersanddeterminestrategies
tocreateahigherdemandforexclusivebreastfeeding(EBF).
Themethodologyused tocollect thedatawasparticipative. Indepth interviewswas
appliedonspecificaspects.
Figure1:AmapofCameroonwitharedcrescentdepictingtherefugeeszones.Source:UNHCR2015
ASSESSMENT OF THE BARRIERS TO EXCLUSIVE BREASTFEEDING IN THE EAST
REGIONOFCAMEROON
TheEastRegionisthelargestofallregionsofCameroonbutintermsofdensity,itis
the leastpopulated. Itspopulation isestimatedat873,891 inhabitantsdistributed in
14healthdistricts.Currently,theEastregionofCameroonhoststhelargestnumberof
Central African refugees (UNHCR, 2015) including 60,000 people from theMbororo
tribe.
Figure 2: Health workers during the practical session Figure 3 Overview of participants during a presentation
Themainobstacleswerecitedbyorderofprioritiesandincluded:
• Rejection of colostrums. The yellowish appearance of colustrum was
associatedwith ibeing “dirty”, spoiled and tainted, because it has stayed for
long in thebreast.The first action is toextract it and throw it away toallow the
“cleaning” of the breast. This practice is mostly done as soon as the woman
delivers, independentlyofwhether thedeliveryhappens in ahealth facility or at
home.Theact of expressing the colustrumand throw it, isusuallyperformedby
elderly women, in particular mother in laws. Meanwhile the newborn is given
sweetenedwater.
• Theperceivedinsufficientbreastmilksupplyisoneofthemostcommonlycited
reasons for early cessation of breastfeeding and early introduction of
complementaryfoods;
• A perceived state ofmalnutrition of themother. It is believed both by health
workers and mothers as the main cause of insufficient milk and the reason for
discontinuing breastfeeding. Green vegetables (“kakko”) and cassava porridge
“kammo”)aregiventothenewbornasreplacementstogivehim“strength”
• Competing priorities. Breastfeeding is not a priority and is perceived as a
stumblingblocktoincomegeneratingactivitiesandparticularlyfarming. Noneof
the30healthworkersknewaboutthemethodofpumping,expressingandstoring
breast milk as a strategy to continue breastfeeding in lactating socio‐economic
activewomen
• Thebelief thatmilk ispoisoned especiallywhen there is a history of previous
neonatal deaths and therefore not breastfeeding is believed to save the live of
newborns.
• For the Bororos of the Central African Republic (a tribe of shepherds nomadic
cattle‐herders),itwasreportedthatprefertofeedcowmilktotheirnewborn;
thecowmilkisperceivedtobericherthanbreastmilk;
• Inurbanareasof theEast regionandparticularly inBertoua,practicing formula
feedingisperceivedasagoodindicatorofahighsocialstatus;
• Low literacyrateof thepopulationand the languagebarrier betweenhealth
personnel and the community who do not usually speak neither English nor
French;
• Ignorance/ lack of accuratenutritional information/knowledge and skills of
healthworkersoninfantfeedingpractices.Ofthe30healthworkersthatattended
the training none of them was consistently asking about the newborn feeding
practices.
STRATEGIESTOIMPROVETHEUPTAKEOFEXCLUSIVEBREASTFEEDINGINTHE
EASTREGION
In other to generate quantifiable and sustainable results of the feeding practices of
infantsoftheEastregion,healthworkersrecommendedthefollowings:
1. Dialoguewithkeyinfluencersoffeedingpractices:traditionalbirthattendants,
and mothers in law with emphasis on inter‐personal communication and
community‐basedapproaches
2. Emphasize themethod of pumping, expressing and storing breast milk as a
strategy to continue breastfeeding in lactating women, given that 85% of the
populationarefarmers.
3. Donotuse classicmedia channels,which are radio and televisionbecause the
signalsdonot reach theareasofDelele,Batouri andKette andelectricpower is
saidtobe“unreliable’.
4. Donotusewrittenpostersandbrochuresbecausethemajorityofthetargeted
populationisilliterate.Pictureswillleadbetterresults.
5. Build the capacity of elderly women and traditional leaders to address
culturalbeliefs incompatiblewithEBFmessages.Theyaremore listened to, than
health workers and community health workers. Moreover tailor messages to
mothersinlawandtraditionalbirthattendants,thekeyinfluencers.
For a long lasting impact of these interventions, the author also suggests the
introductionofthenutritionmodulesinthecurriculumofhealthworkers.