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Managing Malnutrition

August 1, 2008 — St. Anthony’s Parish Church, Freetown, Sierra Leone


Breast-feeding is the natural and most ideal way to feed a newborn infant.  This is because breast milk has all the nutrients in the correct proportion to make a child grow healthy and strong. Every year World Breast feeding week is celebrated from the 1st to the 7th August 2008 with a special theme. This year the theme for World Breast Feeding Week is: Mother Support: Going for the Gold. Any support given to mothers for the purpose of improving breast-feeding practices for both the mother and infant is mother support. 

Breast-feeding is widely practiced in our country but there are problems in the way in which it is done. Mothers need the right support to be able to practice breast-feeding correctly. Babies need to be breast fed early, within an hour after delivery, exclusively, for the first six months of life, and after six months the breast milk must be combined with appropriate complementary foods for two years or more. However some of our traditional practices on breastfeeding are inconsistent with all of these.

As would be expected, the birth of a baby brings joy to the woman’s family and friends. With this joy comes plenty of advice that is not always good for a child. Often the advice relates to the feeding of the child. A very common one is to give warm water to the child soon after delivery. The reason is to clean up the child’s stomach.

From then onwards, giving water to the child becomes the norm if the child cries too much as the breast milk is thought to be insufficient for the child or is having chest burns. Among some tribes in this country, it was the belief that a mother should not give the colostrum to her child because it was not good. If a woman has lost one or two of her babies before while breast-feeding, it is frequently thought that the cause of the child deaths is that her breast milk is bad. As such any other child she gets will not be breast fed for fear she will lose that child. All these practices are due to wrong knowledge and must be discouraged.

Some of them indeed are now changing, as more women get educated. The literacy rate among women is still very low though and many still hold on to the bad traditional practices. Women must be supported to continue breast-feeding for as long as possible but more so during the first six months of life.

The practice of exclusive breastfeeding is a challenge to working women. Most places of work do not have nurseries which permits mothers to be close to their babies while they are at work making it possible for them to be able to take short breaks to breastfeed.

The longest period that a woman working in the civil service can stay home for on maternity leave with her salary is for three months. She is then expected to resume work after this or go on leave without pay. If she opts out to resume work, then she most probably will start complementary feeding very early. Work places must also support breast-feeding by making it possible for mothers to have long enough maternity leave with a salary, or by providing nursery facilities close to their offices.

Sometimes, problems occur with breast-feeding. Some of these include problems with the breast such as inverted nipples, cracks and fissures on the nipple, breast-milk congestion in which the whole breast or part of it become tender and infection may develop in the congested segment resulting in high fever.

Health personnel should be able provide support to women with breast problems so that they will be able to continue breastfeeding.  For a woman to be able to produce enough milk she herself must be well nourished. A lactating woman needs to eat at least one extra meal more than the rest of the family to be able to produce sufficient milk and stay healthy.

The family must support her to do this and husbands in particular should ensure that their breastfeeding wives eat more food and have enough rest while they are breast-feeding. There is also the problem of poverty combined with wrong knowledge. Some women will practice prolonged breastfeeding without complementing the breast milk at six months of age. Breast milk needs to be complemented at six months with an appropriate weaning food.

Many women will not prepare special weaning foods for their babies but will continue to breast feed alone beyond 12 to 18 months at which time the child becomes very thin and underweight and might even develop marasmus (having a skin and bone appearance). Such children could die easily if they are exposed to a serious attack of diarrhoea. Poverty is partly responsible for some women not introducing complementary foods to their babies at the time when it is due. Women must be supported to adequately wean their babies with complementary foods prepared from locally available foods that may be cheaply present around them. Sometimes, taboos prevent women from giving foods that are rich in proteins to a child because these foods are thought to be harmful to the child.

A few examples of these foods are eggs, meat and fish. Adults do not realise that young children need these proteins more because they are growing.  This widespread ignorance and superstition about foods, coupled with poverty is what is responsible for some of the very serious cases of malnutrition seen in some paediatric wards.

With the current global increase in food prices that is taking place families are sure to have difficulty feeding themselves. This is all the more reason why more efforts should be placed on giving the correct advice on infant feeding to mothers. Health personnel should provide the correct advice and discourage wrong traditional infant feeding practices. Exclusive breast-feeding for the first six months should be the norm and all efforts should be made to prevent mothers from giving water to young babies. 

Due to all the wrong infant feeding practices in this country we do have serious cases of malnutrition that need to be treated in hospital. The treatment of these children must follow a standard procedure as they could die easily if the correct protocol is not adhered to. There are many health facilities throughout the country in which severely malnourished children are treated. The death rate in some of these is very high and must be reduced. It is therefore gratifying to note that the Ministry of Health and Sanitation, supported by UNICEF has developed National guidelines for the Management of Severe Acute Malnutrition in Sierra Leone.  

I congratulate the ministry and would like to admonish all facilities looking after severely malnourished children to follow the protocol. I now have great pleasure in launching the World Breast Feeding Week 2008 and the National Protocol for the management of Severe Acute Malnutrition in Sierra Leone. 



Source: Cocorioko.