In 2012 the World Health Assembly endorsed a Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition which included 6 global targets or goals namely:
- 40% reduction of stunting in children younger than 5 years.
- 50% reduction in prevalence of anaemia in reproductive-aged women
- 30% reduction in annual incidence of low-birth weight
- No increase in childhood overweight
- Increase rate of exclusive breastfeeding(EBF) until 6 months postpartum to at least 50%
- Reduce and maintain childhood wasting to <5%.
To help communities achieve these six global targets, WHO outlined 5 priority actions namely;
- Create a supportive environment for the implementation of comprehensive food and nutrition policies.
- Include all required effective health interventions with an impact on nutrition in national nutrition plans.
- Stimulate development policies and programmes outside the health sector that recognize and include nutrition.
- Provide sufficient human and financial resources for the implementation of nutrition interventions.
- Monitor and evaluate the implementation of polices and program.
Efforts to achieve these targets have been minimal and challenging with training being one of the strategies to improve human capacity. However, the focus has been on training mid-level nurses, doctors, community volunteers, or lay counsellors.
In line with the global target of providing sufficient human and financial resources for the implementation of nutrition interventions, CBC Health Services (CBCHS) started a Nutrition Improvement Programme (NIP) in 2007 as an essential component of the AIDS Care and Prevention programme. The overall goal of the NIP is to improve the nutritional status of clients receiving services in the in CBC health units in Cameroon. This is accomplished through education, sensitization, counselling, promotion of optimal breast-feeding practices, and consumption of local food sources.
To date, over 40 nutrition counsellors have been trained and are working in four hospitals, one community-based outreach center and seven integrated health centers in five of Cameroon’s 10 regions. These nutrition counsellors provide nutritional counselling services to clients and patients with various conditions like HIV, diabetes, obesity, anemia, gout, arthritis, hepatitis and general infant feeding (prevention of breast engorgement, proper attachment/positioning to breast). They also demonstrate procedures on preparing enriched pap for infants 6-9 months old, feeding during illness for low weight babies, and follow up infants during Infant Welfare Clinic (IWC)/Well Baby clinics.
The NIP also seek to improve health service delivery in Cameroon by training nurses in the public sector on infant and young child feeding and community health by training peer educators on the promotion of exclusive breastfeeding.
NIP has produced working documents like the Infant and Young Child Feeding Training Manual, Standard Operating Procedures Manual, and a spread that documents the activities.
In 2014, the Nutrition Evaluation Embedding Programme provided funds to CBCHS to evaluate the Effectiveness and Acceptability of CBCHS’ Nutrition Improvement Programme on Caregivers’ Infant and Young Child Feeding (IYCF) practices. The results from the cross-sectional survey suggested that caregivers who received nutrition counselling services were 6 times more likely to practice exclusive breastfeeding and their children are less likely to be stunted. This provides evidence that this form of breastfeeding promotion is effective in improving breastfeeding practices.
As part of the evaluation of the Nutrition Improvement Programme, a software programme OneHealth was used to determine impact of exclusive breastfeeding and cost per life saved. The programme allows the user to insert existing costs of training, human resources, logistics, and equipment to illustrate the health system implications of scaling up intervention delivery. The analysis showed that with an investment of approximately $25 per child and exclusive breastfeeding scaled up to 90% across Cameroon, 1,759 additional deaths in children under five could be prevented.
Infant feeding counselling was shown to increase caregivers’ knowledge and improve breastfeeding, complementary feeding and improve children’s linear growth and weight gain.
Abstracts have been prepared and presented orally at international meetings as follows:
- “My Testimony is the Growth of My Baby: Effectiveness of the Nutrition Improvement Programme on Infant and Young Child Feeding and Nutritional Status.” June 2016 Christian Connections for International Health Conference, Baltimore’.
- “We Pass Out Information with Doubts on Our Faces’: Training Nutrition Counselors in Infant and Young Child Feeding.” Oct. 2015 American Public Health Association Annual Meeting, Chicago, IL.
- “Nutrition Improvement Programme: Building an Enabling Environment for Nutrition Specific and Nutrition Sensitive Actions.” at 1,000 Days of Life: New Approaches For Integrated Strategies to Improve Children’s Lives. Catholic Relief Services Integrated Nutrition Conference, Nairobi, Kenya. Sept. 2015.
- “Mami, Bobbi Be Na Fayne Chop”: Effectiveness and Acceptability of the Nutrition Improvement Program on Infant and Young Child Feeding and Nutritional Status West African Health Organization Good Practices Forum in Health, Ouagadougou. Jul. 2015.