100O Most Critical Days battling Malnutrition

WHEN a country has a problem it is guaranteed that the worst hit will be the mothers and their children.

 80 percent of the rural population of Zambia’s 13 million people lives in Poverty.

This is evident when one goes through the many rural and even urban areas of Zambia where many children and even adults are perpetually hungry.

Over 45 percent of children in Zambia are stunted in growth, 15 percent are wasting (their height is not in proportion to their weight) and 5 % are underweight.

There are many causes of malnutrition the major one been wrong feeding of babies.

It is recommended that a child be breast fed exclusively before it attains 6 months of age, yet some women say that they cannot afford to breast feed exclusively citing lack of food as a reason.

The predominant myth is that if a mother does not have much to eat then her breasts will not emit milk but according to the National Food and Nutrition Commission (NFNC) this is a myth.

Another factor that contributes to malnutrition would be the environment a child is coming from.

Janet Phiri‘s three children are malnourished and if one looks around her yard and the community she lives in, the evidence is there to see.

Not only does her yard lack a toilet but she also has to trek miles to get water a situation which many do not know also contributes to stunting.

The Lancet series Nutrition Series of 2008; after looking at the impact of hygiene interventions (hand washing, water quality treatment, and sanitation and health education) concluded that they could contribute to a 2-3% reduction in stunting.

The series which focuses on among other things the effects of nutrition interventions states that more than a third of child deaths and 11% of the total disease burden worldwide are due to maternal and child under nutrition.

And Zambia is among 36 countries with more than 20% stunted growth in children worse still is the National Food and Nutrition Commissions (NFNC) revelation that Zambia has highest levels of malnutrition of children below the age of five in the SADC region.

These figures are hardly credentials to be proud of.

When the effects of malnutrition are not reversed by the age of two years the damage is permanent as.

The damage frighteningly ranges from affected cognitive development to disability, morbidity and even mortality.

Prioritizing nutrition in national development yields significant economic benefits - one study has found that improving nutrition during childhood can increase earnings in adult life by up to 46%.

This can only be done through concerted efforts by everyone as Dr Cassim Masi, Director of National Food Nutrition Commission (NFNC) illustrates;

“Malnutrition affects all Zambians; the clock is ticking as we are still in the era of millennium development goals.” The Doctor says

The Millennium development goals (MDGs) are meant to provide a framework for the entire international community to work together towards a common end.

This is to ensure that human development reaches everyone, everywhere.

According to the United Nations Millennium Development Goals basic information Toolkit; 

“If these goals are achieved, world poverty will be cut by half, tens of millions of lives will be saved, and billions more people will have the opportunity to benefit from the global economy.’

And the MDG number 1 is to eradicate extreme poverty and hunger

A programme meant to fight malnutrition and its effects might change all this.

The first 1000 Most critical Days Programme (MCDP) is one such initiative aimed at preventing stunting in children less than two years of age.

The programme which is based on the Strategic Direction One Plan is enshrined in the National Food and Nutrition Strategic Plan (NFNSP) is meant to last for three years from 2011 to 2015.

A child’s most critical period in terms of prevention of malnutrition are the first 1000 days of its life beginning from conception.

Thus it refers to the first critical 1000 days of a child’s life beginning from conception; 270 days of pregnancy plus 365 days of the child’s first year and the 365 days of its second year.

The MCDP will be carried out by the NFNC with support from Communication Support for Health (funded by the USAID) and the Zambian Government (through its line ministries).

According to Freddie Mubanga who is the Chief Nutritionist- Head of Public Health and Community Nutrition at the NFNC the interventions have been going on for some time.

“The interventions have been ongoing but through the Global Scaling up Nutrition (SUN) we are trying to increase key interventions.”

The line ministries responsible for carrying out the program are; Ministry of Community Development, mother and Child as well as the Ministries of Education, Agriculture, Health and Ministry of Local Government and Housing .

One might ask what benefit the 1000 days campaign will offer the young baby and its mother.

By targeting a woman of childbearing age the foundation is led and as soon she discovers she is pregnant the 1000 days of her child’s care are initiated.

The entire 270 days of pregnancy (from conception) are vital thus care must be given in terms of ante-natal care, folic acid and iron supplements and good nutrition.

Women are de wormed, vaccinated and are encouraged to consume iodated salt and sleep under a treated mosquito net.

As soon as the baby is born its entire first year (365 days) is dedicated to its survival, exclusive breastfeeding (which is the best bet one has of raising a properly nourished child).

 Other important elements are feeding of appropriate complimentary foods after six months, continued breastfeeding, vitamin A supplements as well as vaccinations.

 

Women are also encouraged to attend growth promotion sessions to check the weight of their babies every month as well as for them to sleep under mosquito nets.

This chain of activities continues into the second year of the baby’s life (365) days in addition to which mothers are taught what the best foods are to feed their children.

 It has always been said that there is unity in purpose and this is something that William Chilufya who is coordinator for Civil Society for Scaling Up Nutrition Alliance (CSO-SUN) feels strongly about.

“We identified certain problems with regard to nutrition from the civil society perspective, we noticed that there was fragmentation each group was working on different stuff.

We made an alliance and drew up a proposed scale up nutrition plan for mothers and children for the 1000 MCDP.”Mr Chilufya says

The Scaling up Nutrition (SUN) is designed by the Standing Committee on Nutrition at the United Nations (UN).

The major question one would ask is what is the CSO-SUNs role in the 1000 MCDP?

The programme encompasses the civil society, donors, private sector and the Government to help eradicate nutrition in the country.

For CSO-SUN their primary role is to ensure that whatever has been planned in terms of First 1000 MCDP is achieved.

“Our work with the NFNC and basically the Government involves us looking at their policies and ensuring that whatever has been written down planned and budgeted for is what actually happens.”

Mr Chilufya adds that the organization will analyze the programmes implementation and advice on how it can improve if need be.

“Our role is also to verify whether people at the grassroots level are actually benefiting from the MCDP, because the primary goal is to address the needs of the people.”

The needs of the people lie mainly in preventative measures because treating malnutrition is expensive.

  

Ministry of health, Chief Nutrition Liason Officer Agnes Aongola says preventing malnutrition is definitely cheaper than treating it.

“Some of the treatments such as Ready to Use Therapeutic Feeds (RUTF) range from as much as 50 dollars per child.”

She adds that the figure is significantly higher as the RUTF is given in tandem with other treatments; imagine how much difference that money would make if it was used in prevention.

If that 50 Dollars was used in prevention one can only imagine the difference it would make, the issue is prioritization as Mr Chilufya puts it.

“The health policy has all kinds of good topics on nutrition meaning we know what to do but what we need to work on is our ability to implement.”

One of the main issues hampering implementation according to him is funding which he says is not as satisfactory as it should be to the health sector.

This is an issue which the organization presented to the Expanded Parliamentary Committee on estimates of revenue and expenditure, and they are satisfied that an impact was made thus changes are in sight.

“Going to Parliament and talking to MPs at that level means that we can engage policy makers and decision makers as this is our goal.”

The organization is funded by the Department for International Development (DFID) and Irish Aid emphasizing Mr Chilufya’s point about cooperation.

Perhaps the First 1000 MCDP will be shelter from the malnutrition storm, Zambia has encountered for decades.

And only then will the burden of death and treatment of malnutrition cases end.

It is time the chain of malnutrition was broken.