Ensuring Effective Caring Practices within Families and Communities

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Ensuring Effective Caring Practices within
Families and Communities

• Isatou Jallow
• Executive 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 childrens
  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 childs stress
• Providing shelter and clothing
• Feeding, bathing supervision of childs 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 lt1year 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 childs 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)
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Women Produce, Reproduce, Nurture, and Care
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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 mothers 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 gt44 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)
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Women and Children

• Infant feeding practices exclusive
  breastfeeding rates infants lt6months 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
Huffman, et al., 2000
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The Burden of Malnutrition

• Haunts you through your whole life - Impacts the
  next generation

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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 worlds 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
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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?
• Fathers 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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Village Support Group on Infant Feeding
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Baby Friendly Rest House at the Fields
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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 its greatest
national resource, the intellectual power of its
people. But that is precisely what is happening
where low birth weight is common, where children
fail to achieve their full potential growth,
where micro-nutrient deficiencies permanently
damage the brain, and where anaemia and
short- term hunger limit childrens perform- ance
at school. (Nutrition Foundation for
Development UN SCN, 2000, Geneva)