Ensuring Effective Caring Practices within Families and Communities
Isatou JallowExecutive Director
National Nutrition Agency (NaNA)The Gambia
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Overview of Presentation
Background on care, caring practices, indicators
The situation of women and children
How do we ensure effective caring practices within families and communities?
The way forward
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How important is Care in the African context?
An African Regional Nutrition Strategy (1993-2003) adopted by the then OAU African Council of Ministers at their 58th session in 1993 cited inadequate care as an important factor in the poor nutritional status of women and children in Africa. This according to the strategy, was due to the disappearance of the traditional African extended system.
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Defining Care and Caring Practices
“Behaviours and practices of caregivers to provide the food, health care, stimulation and emotional support necessary for children’s healthy growth and development”
3 categories of Care:
Nutritional, Psychosocial and Physical
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Breastfeeding = Foundation for Care
Breastfeeding the act
combined with breastmilk the product cuts across all the categories of
care
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Examples of caring practicesin all three categories
Breastfeeding Providing emotional security Reducing the child’s stress Providing shelter and clothing Feeding, bathing supervision of child’s toilet Preventing and attending to illness Nurturing and showing affection Interaction and stimulation Playing and socialising Protecting from exposure to pathogens providing a relatively safe environment for exploration
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Child Development
Multi-dimensional and inter-dependent Social, emotional, cognitive and motor
performance
Patterns of behaviour
Health and nutritional status
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Child Development
Early years (first 3) critical foundation for healthy psychosocial development - intelligence, personality and social behaviour
Brain development <1year is rapid and extensive and is vulnerable to environmental influence – nutrition, health, care and stimulation.
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Child Development
Early stimulation such as talking, singing to the child makes the child more responsive
A child’s capacity for mental and social development depends on biological systems shaped by early experience and attachment
Studies show that children who have secure attachments early in life, function better in society and perform better in school
Stimulating a child is like motivating a worker – the output is greater
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Nutrition Security and Early Childhood Development
Nutrition Security – Food security coupled with a sanitary environment, adequate health services and knowledgeable care to foster good nutritional status through the life cycle and across generations
Food; Health; Care; Safe Environment
Early Childhood development – an integrated approach that promotes a holistic view of the chid and a coordination of activities in the five priority areas – health, water, hygiene and sanitation, nutrition, early stimulation/education and protection
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UNICEF conceptual framework of the determinants of nutritional status (IFPRI/Benson 2004)
Household food security
Quality of care
Healthy environment,
health services
Nutritional status
Dietary intake
Health status
Outcome
Immediate determinants
Caregiver resources
knowledge & access to education
health status control of
resources
Resources for health
availability of public health services.
sanitation, access to clean water.
Food security resources
quantity food produced
quality food produced, diet diversity
cash income food transfers
Underlying determinants Poverty constrains the level of these determinants for individual households.
Political & ideological framework
Economic structure
Potential resources Human, agro-ecological, technological
Basic determinants The impact which the resources potentially available to the household have on nutritional status is mediated & constrained by overarching economic, political, and institutional structures.
Institutions
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Care for the Caregiver
“Mothers and babies form an inseparable biological and social unit; the health and nutrition of one group cannot be divorced from the health and nutrition of the other” (Resolution WHA55.25 on Infant and Young Child Nutrition).
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Caring practices
Family planning services – contraceptive use Ante-natal care Skilled attendance at birth Post-natal care Maternity protection laws Education Reducing workload during pregnancy and
lactation Reducing the mother’s stress Showing care and affection for the mother
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Indicators of Care for Women and Children
Child Mortality Rates Nutritional status –
underweight, stunting, wasting
Exclusive breastfeeding rates
Complementary feeding Immunisation coverage Use of insecticide treated
nets Provision of clean water and
adequate sanitation
Maternal mortality rates Low Birth Weight Family planning services –
use of contraceptives Micro-nutrient deficiencies Proportion of household
utilising Iodised salt Vitamin A supplementation
coverage Skilled attendance at birth Proportion of children
attending early childhood centres
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The situation of Women and Children
10.8 million children die each year in the developing world
41% of child deaths from Sub-Saharan Africa
Risk factors include unhygienic environment, unsafe and inadequate water, poor sanitation and undernutrition as an underlying factor
Maternal mortality estimated at 940 per 100,000 for sub-Saharan African (UNICEF SOWC 2005).
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Women and Children
14 out of 18 countries with Neonatal Mortality Rates of >44 per 1000 are from Sub-Saharan Africa
Countries in conflict situations register the highest rates
Maternal Health and health care are important determinants of neonatal survival
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Child Mortality Rates and Nutrition status in Africa (0 – 5 years)
Region/
Sub-
region
Child Mortality
Rates
Deaths per 1000 births
2002
Prevalence of stunting %
<2SD height for age
1990 2000
Number of stunted children
millions
1990 2000
Africa 154 36.9 35.2 39.6 45.1
Western 186 34.7 32.9 10.9 12.7
Central 193 42.2 37.8 5.6 6.8
Eastern 154 44.4 44.4 15.8 19.4
Northern 42 27.4 21.7 5.8 4.6
Southern 156 25.4 24.6 1.5 1.5
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Women and Children
Infant feeding practices – exclusive breastfeeding rates infants <6months 28% for SSA, 50% of children between 20-23 months still breastfeeding
Utilisation of preventive health services e.g. immunisation of children less than desired
Female literacy levels low but progress in some countries
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Foetal Nutritional status – proxy indicator of maternal nutritional status
Percent Low Birth Weight (<2.5 kg) in Africa
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6
1314
9 9
17
10
13
98
1311
14
11 1112
0
5
10
15
20
25
Per
cen
t
Huffman, et al., 2000
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The Burden of Malnutrition
Haunts you through your whole life - Impacts the next generation
OLDER PEOPLE
Malnourished
BABY Low
Birthweight
CHILD Stunted
ADOLESCENT Stunted
WOMAN Malnourished
PREGNANCY Low weight gain
Inadequate food, health, &
care
Reduced capacity to care for child
Higher mortality
rate
Impaired mental
development
Increased risk of adult chronic disease
Inadequate catch-up
growth
Untimely / inadequate feeding
Frequent infections
Inadequate food, health, & care
Reduced mental capacity
Inadequate food, health, & care
Inadequate food, health, & care
Higher maternal mortality
Inadequate fetal nutrition
Inadequate infant nutrition
Reduced physical labor capacity,
lower educational attainment,
restricted economic potential,
shortened life expectancy
Reduced physical labor capacity,
lower educational attainment
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Challenges to effective caring practices
Economic/Political High poverty levels and several countries in
conflict situations, governments unable to provide basic public services
Health Services/Disease burden HIV/AIDS, Malaria, Micronutrient
deficiencies
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Challenges
Sub-Saharan Africa with highest HIV/AIDs prevalence figures
Africa with highest fertility risks in the world “too frequent + too soon – early marriages
SSA with 30% of world’s Maternal deaths Low access in many countries to clean water
and sanitation – rural/urban disparities Low maternal literacy levels
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Family & Community 12 Practices for Child Survival, Growth, Development (WHO, 2004)
Immunisation Breastfeeding Complementary feeding Micronutrients Hygiene Treated Bed nets Foods and fluids during illness Home treatment Care seeking Adherence Stimulation Antenatal care
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Ensuring effective Caring practices within families and communities – Who is responsible?
Stakeholders at different levels of society
Actions at different levels of society
Stakeholders and Actions complement each other
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Linking Stakeholders and Actions
Macro actions – Government level
Policies
Meso actions –Service delivery
Level- provision ofServices e.g.
Immunisation, NutritionInformation, training
Micro actions –Communities,
Households e.g.Utilisation of
services
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Macro – Meso - Micro Actions
Government Polices – maternity protection laws; food fortification laws, National Code of marketing of breastmilk substitutes
Service delivery level – immunisation, vitamin A and iron supplementation, nutrition and health education
Community/Household level – visits to service delivery centres for care, brestfeeding, hygienic practices
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Care-giving across generations – Grandmothers and Siblings – singing, dancing, feeding,
comforting
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Fathers as caregivers – time to document fathers’ contribution
Can fathers be encouraged to take a more active role in care-giving?
Father’s contribution to care-giving – is it being underestimated?
Fathers smoking away from their families – a caring practice?
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Ensuring effective caring practices within families and communities – An example
from The Gambia
The Baby Friendly Community Initiative - Promoting Exclusive breastfeeding
Building on Traditional and local knowledge, beliefs and practices
e.g. communities’ local knowledge of young animals being breastfed exclusively for a period of time and surviving
Traditional shelters at the fields to enable lactating mothers take their infants to the fields
Involvement of men in all aspects of the intervention Supporting communities to create an enabling
environment
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Local communities disseminating messages through songs and dances on maternal/infant nutrition, environmental sanitation/personal
hygiene
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The Lancet Child Survival Series(caring practices)
Interventions to reduce Child Mortality Rates
Preventive Treatment Breastfeeding 13% Insecticide Treated Nets 7% Complementary Feeding
6% Clean delivery 4% Water/sanitation/hygiene
3% Vitamin A 2% Tetanus Toxoid 2% Newborn temperature
management 2% Measles vaccine 1%
Treatment Intervention Oral rehydration therapy
(ORT) 15% Antibiotics for sepsis 6% Antibiotics for pneumonia
6% Antimalarials 5% Newborn resuscitation 4% Antibiotics for dysentry 3%
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The Way forward - Questions to ask:
How can we achieve universal coverage with these interventions?
What local skills and knowledge do families have on ECD and care for mothers and their children?
What additional skills and knowledge do they need to improve current caring practices?
How can local knowledge and skills be used positively to enhance caring practices?
How can local practices that ensure psychosocial stimulation of children be documented and promoted?
What is the situation of care for the girl child? Do communities and families recognise the vulnerability of the
adolescent girl? Educating the girl child – is it recognised as a caring practice
by communities and families?
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Questions to ask:
Care and Support for women during pregnancy and lactation – how can men be supported to take an active role?
What child caring activities can men participate in? What is the role of the traditional media in promoting effective
caring practices? How are international rights instruments understood at the
local level – within families and communities? How can we ensure that governments reporting on the CRC
include indicators pertaining to caring practices and Early Childhood Development?
The Vulnerable among the Vulnerable – women and children living with HIV/AIDS and or living in conflict situations – how do communities and families cope – what resources do they require to ensure adequate care?
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Millennium Development Goals, Care and ECD
Reduce extreme hunger and poverty Achieve universal primary school
education Promote Gender equality and empower
women Reduce Child mortality Improve maternal health Combat HIV/AIDS, malaria and other
diseases
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Care-Nutrition-Early Childhood Development-Socio-Economic Development
“No Nation can afford to waste itsgreatest national resource, the intellectual power of its people. Butthat is precisely what is happening where low birth weight is common, where children fail to achieve their full potential growth, where micro-nutrientdeficiencies permanently damage thebrain, and where anaemia and short-term hunger limit children’s perform-
ance at school.” (Nutrition: Foundation for DevelopmentUN SCN, 2000, Geneva)
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