First Published in TimeScape Magazine
Ngala Elvis Mbiydzenyuy
CEO/Founder Maternal and Child Aid Cameroon
A study “How many child deaths can we prevent this year? conducted by Jones, Black and Morris estimated that exclusive breastfeeding for the first six months of life could reduce infant mortality rate by a remarkable 13%. Exclusive breastfeeding has been defined as feeding an infant with breast milk only without giving any other foods, not even water. The definition allows for prescribed medicines, immunizations, vitamins and minerals supplements. The risks of not breastfeeding have been highlighted. These include high infant mortality as a result of reduced protection against certain preventable deaths from infectious and possibly also chronic diseases, gastrointestinal infection and delayed recovery from illness. In Dhaka, Bangladesh, it has been reported that partial or no breastfeeding was associated a 2.23-fold higher risk of infant deaths from all causes.
There are many cultural and practical obstacles to the practice of exclusive breastfeeding. Some traditional beliefs, practices and rites encourage use of pre-lacteal feeds, as well as giving extra water, herbs and “teas” to breastfeeding babies. In rural Yoruba communities in Nigeria, exclusive breastfeeding is considered dangerous to the infant who is thought to require water to quench thirst and promote normal development. Many women start mixed feeding because they have to resume work or even return to school.
In Cameroon, breastfeeding remains a culturally accepted practice with up to 99% of women initiating breastfeeding. However, exclusive breastfeeding rates remain low in the country. According to the Uganda Demographic and Health survey 2000–2001, 62% of children under six years of age were exclusively breastfed as compared to 74% of those aged under four months. Similar values in Cameroon are yet to be documented. The challenge is how to scale up exclusive breastfeeding to universal levels.
An additional problem in Cameroon and supposedly Africa as a whole, over the last two decades has been the potential transmission of HIV through breast milk. A recent study from Zimbabwe indicates that postnatal transmission of HIV can be halved from 14% to 7% by exclusive breastfeeding in the first three months. There is circumstantial evidence that the fear of spreading HIV to their infants through breast milk has scared mothers, some of whom may not know their HIV sero-status, with resultant negative influences on their breastfeeding practices. On the other hand, recent studies done in Africa have reported that women who are HIV-positive continue to breastfeed to avoid stigmatization by their families and communities.
Several initiatives to improve exclusive breastfeeding have been tried with varying success. These include: the implementation of Baby Friendly Hospital Initiative (BFHI) recommendations (10 steps to successful breastfeeding) in maternity hospitals, education of mothers on how to breastfeed successfully, paternal support and use of peer counselors to support breastfeeding mothers. The purpose of BFHI is to actively protect, promote, encourage and support breastfeeding through education of health care workers in maternity and neonatal services. It also accredits hospitals and maternity units that demonstrate that they meet the WHO/UNICEF criteria as a Baby Friendly Hospital. However, using health workers to give early support for exclusive breastfeeding in Italian women was reported as ineffective. This calls for further research to identify reasons for this finding since it contrasts the findings reported in the Cochrane review of breastfeeding support using 13 trials where provision of extra support to mothers by professionals with special skills in breastfeeding led to increase in the number of mothers exclusively breastfeeding up to two months. Program data from Ghana, Madagascar and Bolivia used several methods which included skills training, harmonized messages and peer group support and interaction to promote breastfeeding in the community. The rates of timely initiation of breastfeeding and exclusive breastfeeding increased over the three year period of implementation of the program.
In Cameroon, where the majority of women deliver outside health facilities, the BFHI strategy alone, being hospital based, would miss out most mothers. One way of improving exclusive breastfeeding levels is through support of breastfeeding mothers by peer counselors. Peer counseling is an effective way of promoting exclusive breastfeeding and it has also been reported to decrease the speed of weaning. Haider and others report an improved rate of exclusive breastfeeding at five months of age in a group of mothers supported by peer counselors (70%) compared to the control group (6%). In Ghana, lactation counseling was reported to lead to increased exclusive breastfeeding rates using the “previous month” exclusive breastfeeding. Most of the reports on peer counselors have come from high income countries, Eastern Europe and Asia. Hitherto there is no experience with the use of peer counselors for promotion of breastfeeding in Cameroon.
Clinicians, public health advisors, nutritionists and others have been attempting to increase breastfeeding rates, using the initiatives listed above, for the last few decades with varying degrees of success. However, health-related behaviors do not occur in isolation: by recognizing the importance of community social circumstances we can improve our understanding of infant feeding, thereby improving our ability to increase breastfeeding in our communities.
The Institute of Science Technology Breastfeeding Research and Advocacy Center coordinates efforts by organizations, agencies, institutions, and individuals towards the development of strategic plans, policies, and goals for breastfeeding and ensures that breastfeeding practices and attitudes are enforced in Cameroon (particularly in the rural areas) and given priority as an indispensable step to achieving Millennium Development Goal four (4). The initiative is unique among existing malnutrition-prevention efforts in its focus on programs and activities that promote early breastfeeding initiation as a primordial factor influencing infant nutritional and growth status.
Poor breastfeeding practices will result to frequent hospitalization of infants, poor nutritional status, increase infant mortality and an unproductive community. Exclusive breastfeeding will reduce incidence of disability adjusted life years (DALYs). Healthy babies, healthy communities. This will hugely be achieved with the use of trained community based peer counselors. Training of community breastfeeding peer counselors will increase the breastfeeding rates through early initiation and duration of breastfeeding.
Healthy babies, healthy communities