Daily, Nigeria loses about 2,300 under-five year olds and this ranks the country as the second largest contributor to under–five mortality rate in the world. Sadly, over two-thirds of the deaths are associated with inappropriate feeding/poor practices.
Investigation also showed that complementary feeding begins too early or too late while the foods are often nutritionally inadequate and unsafe. As a result, most of the children come down with malnutrition. Those who survive are frequently sick and suffer life-long consequences of impaired development.
Meanwhile interventions through exclusive breastfeeding and appropriate infant and young child feeding could avert these deaths which occur during the first year of life.
Also, findings by Sunday Vanguard showed that factors, including continued violation of the International Code of Marketing of Breastmilk substitutes (BMS), national regulations by manufacturers of BMS products, ignorance of health practitioners, nursing mothers crave for breastmilk substitutes and inappropriate infant feeding, are major contributors to child mortality in Nigeria. Chioma Obinna reports.
Why would a mother not breastfeed her child? If our mothers had known, if they had had the opportunity of understanding the importance of appropriate infant and young child feeding and the effect on national economic development, perhaps many of us would have done better in our various fields. But research shows that simple things like introducing babies to breast within 30 minutes of birth and breastfeeding exclusively for the first six months as well as continuing with appropriate complementary feeding would reduce infants mortality. Even today’s mothers who are more informed are making the situation worse.
The campaign about the nutritional status of children in the first six months of life makes no meaning to many of them. Some have infant joined the bandwagon of those in favour of breastmilk substitutes even when they have no health challenges. Women whose husbands ordinarily could not afford infant formula are made to go through a lot of financial stress. It is almost becoming a status thing among women. Also the healthcare givers who should know better are aiding improper feeding of these newborns.
Mrs. Vera Odibu is one of these Nigerian women who are yet to be convinced on the need to breastfeed their babies exclusively for six months. “I did not breastfed my two children exclusively and I don’t intend to do that in the future. Infact, it is not possible,”Vera declared.
A bank executive, she believes that breastfeeding is for full-time house wives. However, her children have been denied the benefits of human milk which experts say is better than any food. Science has proved that breastmilk is a complex living substance like blood with a long list of active germ-fighting and health-promoting ingredients.
While Vera is wallowing in ignorance, Gladys Ejifoma was denied the opportunity of adding to the country’s Exclusive Breastfeeding Rate (EBR) which 2013 National Nutritional Health Survey, NNHS, put at 17 percent compared to about 63 percent in Ghana.
Gladys was eager to change but the failure of nurses to prepare her for lactation during ante-natal visits denied her the opportunity.
“I tried all I could but my breast was not bringing milk. I was asked to do all manner of things including using native comb to massage my breasts. I took all kinds of food but all to no avail,” she stated.
Four months after, she noticed some change in her nipples. Further examination showed that she has inverted nipples.
“I was able to correct it but it was late. It was my first child. I had no experience. I think nurses should be re-trained on some of these things. I delivered my baby in hospital under the supervision of health workers. Nobody told me about inverted nipples; all I was told was to clean my nipples. It is even the nurses that will encourage you to give milk.”
Simple massaging of the breast would have solved Gladys’s problems but she did not have that information.
Vera and Gladys are lucky to have their babies alive, but Mrs. Maymunar Ali was unfortunate. Her child died at four months, no thanks to diarrhoea. Maymunar had all going well for her until she resumed work after three months of maternity leave. Owing to the fact that the company where she worked had no crèche, Maymunar was forced to leave the child at home with a house maid. She was confident that the baby had enough to eat and drink since she had one week before resumption introduced the baby to infant formula. But little did she know what fate had in stock for her. It was around 11am when her phone rang. The maid at the other end of the phone told her to return home as fast as she could .
She ran back home only to find her baby almost dead. She rushed her to hospital. The baby was dehydrated and was diagnosed with diarrhoea. The baby was treated and discharged. A month after, the diarrhoea came back but this time more serious. Efforts to save the baby proved abortive. Maymunar lost her child.
Maymunar’s child would have been among the 800,000 babies WHO says would have been saved every year, with increased breastfeeding.
According to WHO estimates, nearly half of all diarrhoeal diseases and one-third of all respiratory infections in children in low-and middle-income countries like Nigeria could be prevented with increased breastfeeding. Unfortunately, this remains a tall dream in Nigeria.
“Children who are breastfed perform better in intelligence tests, are less likely to be overweight or obese, and less prone to diabetes later in life. Mothers who breastfeed also reduce their risk of developing breast and ovarian cancers. At current breastfeeding rates, an estimated 20 000 deaths from breast cancer are prevented and an additional 20 000 could be saved if rates improved”, the world health body said in a report.
The WHO report published in Lancet Journal, it was found that 1 in 5 infants are breastfed for 12 months, and only 2 out of 3 between 6 months and 2 years receive any breast milk in low income countries like Nigeria.
However, to promote breastfeeding, the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes in 1981 to protect the public from inappropriate marketing strategies. Today, the code is weakly enforced in Nigeria among many other countries. As a result, WHO says, aggressive marketing of breast-milk substitutes is undermining efforts to improve breastfeeding rates, with global sales expected to reach US$ 70.6 billion by 2019.
To address this issue, the Global Breastfeeding Advocacy Initiative, led by UNICEF and WHO, has been at the forefront of the efforts to improve breastfeeding rates in Nigeria.
Only last week, the National Agency for Food and Drug Administration and Control, NAFDAC, raised the alarm over the continuous violation of the Breastmilk Code in Nigeria.
The Acting Director General, Mrs. Yetunde Oni, said: “One of the challenges of ensuring proper feeding of infants has been the continued violation of the International Code of Marketing of Breastmilk Substitutes (BMS) and national regulations by manufacturers of BMS products.
According to her, the ignorance of health practitioners, who have constantly supported the wrong practice, has also contributed to the gravity of violation currently being practiced in Nigeria.
In an interview with Sunday Vanguard, the Deputy Director, Food System and Applied Nutrition, NAFDAC, Abdulsalam Ozigis, blamed the violation of BMS on the poor breastfeeding rate in the country.
“There is need to encourage mothers in the workplace by providing lactation rooms as well as ensuring six months maternity leave for women. Once the breastfeeding rate is dwindling, it encourages improper marketing of breastmilk substitutes. We are not saying it is an illegal product but we are saying every animal should feed its kind with its own brand of milk, it is only the women that are feeding their own kind with lower animal milk and that is absurd: Ozigis said.
Also in a chat with Sunday Vanguard, Lagos State Team Lead, Alive and Thrive/360FHI Project, Dr Uche Ralph-Opara, recommended that women should be able to breast feed their babies 30 minutes after birth. “It may be a struggle; even those who did elective Caesarean Section, CS, may still be in pain but it is all about determination? Ralph-Opara said.
Dismissing the claim of poor milk flow, she said: “A lot of ignorance is a problem. The first day, a baby needs about 7 or 10MLS of breastmilk so if you are able to get up to 7Mls of Colostruim, the first milk produced by a woman, by the next day, you start to produce milk. What people need to understand is that the more the baby latches and suckles, the more they will produce milk but the longer the baby is away from them there are chances that they won’t be able to produce much.
“It is a demand and supply thing. The more the baby suckles, the more you are able to produce and express.” Advocating six months maternity leave for the promotion of the breastfeeding rate in the country, she said companies should provide crèches where mothers can keep their babies while in office.
Stating that breastfeeding was cheaper than breastmilk substitutes, Ralp-Opara, who is also a nursing mother, explained that in terms of the cost, the substitutes are more expensive. “The cheapest infant formula costs N6000 and not everybody can afford it.”
Giving a report on the challenges of Infant and Young Child Feeding, IYCF, a Director at the Federal Ministry of Health, Rakiya Idris, disclosed that the National Nutritional Health Survey, NNHS, shows that in 2015, 32.9 percent of Nigerian children were stunted, 7.2 percent wasted while 19.4 percent were underweight, hence, the need for appropriate infant and young child feeding to revert the trend.
Idris explained that investment to the tune of N182.4 billion would avert 890,000 stunting in five years and save about 123,000 lives each year.
Idris who noted that the period of transition from exclusive breastfeeding to complementary feeding was crucial in ensuring better nutrition for a child.
Health watchers are of the view that breastfeeding is a high impact intervention to achieve the Global Strategy for Women and a roadmap for ending preventable deaths in a generation.
To them, breastfeeding is not only important to child survival but also ensure that children can thrive and reach their full cognitive and developmental potentials.