Photo: Phuong Tran/IRIN

Grandparents have more say over breastfeeding than mothers in some communities, say health workers

ZINCKO,  – Health centres in Burkina Faso tell mothers to feed their babies only breast milk until they are six months old to boost their immune systems, but this advice goes unheeded when the women return home.

This is the second article in a five-part series marking World Breastfeeding Week and the undertapped yet life-saving potential of the practice in West Africa.

Even if mothers agreed to feed their babies only breast milk – called exclusive breastfeeding – the real decision-makers in child care are grandparents. “Children do not belong to only their parents in African society,” said D. Marc Sawoudogo, a nurse and director of the village clinic in Zincko, Kaya health district, 100km northeast of the capital, Ouagadougou.

“Here, the grandparents take the babies as soon as they get home and dismiss the parents as if to say, ‘Who do you think you are?’ It is the old ladies who block exclusive breastfeeding from taking root,” Sawoudogo commented. “You do not go against an African grandmother – I am a nurse and still have a hard time being diplomatic with my mother on these issues.”

Breast milk not only contains life-saving nutrients, but also antibodies that boost babies’ immune systems against pneumonia and diarrhoea, the biggest child killers, the World Health Organization (WHO) has noted.

West and Central Africa have some of the world’s lowest exclusive breastfeeding rates – only 20 percent – and also one of the highest regional averages in infant mortality – 108 deaths per 1,000 live births – according to the United Nations.

A 2006 study estimated that improved breastfeeding practices in West and Central Africa could save 300,000 lives annually.

Initial findings in an ongoing study funded by the UN Children’s Fund (UNICEF) on breastfeeding practices in Burkina Faso have shown that efforts by health centres to educate women about breastfeeding practices have little impact, said Marcel Daba Bengaly, the study coordinator.

“They are told what to do about breastfeeding at the delivery ward, but when they get home they are faced with parents who do not agree to feed the baby only breast milk, so the advice is not heeded,” said Bengaly.

Yet a multi-agency report in 2008 noted that exclusive breastfeeding has increased in other communities.

Over a decade, the number of babies from newborns to five months old who were exclusively breastfed increased from 10 percent to 43 percent in parts of Benin, from seven percent to 54 percent in Ghana, and from eight percent to 38 percent in Mali.

This was achieved by means of theatre and flipcharts, volunteers and village leaders, local media and grandmothers, but much remains to be done: overburdened and sometimes illiterate community health workers, lack of follow-up and discontinued programme support were listed as challenges in the report.

In Zincko village, clinic director Sawoudogo said he would like to talk to the grandmothers about allowing their daughters to breastfeed exclusively, but this would require money.

“These ladies will not come out for nothing – we need to approach them with some token, an incentive, like when we bring kola nuts to meet with village chiefs. We do not make enough to pay for kola nuts with our own salaries,” said the clinic director. “No kola nuts, no grandmothers.”

pt/he source.www.irinnews.org

Photo: Phuong Tran/IRIN

Nafissa Haboubacar tries to breastfeed her two-month-old, with difficulty

ZINDER, – While health workers counsel women in Niger to feed their newborns until age six months only breast milk, to boost their babies’ immunity and avoid malnutrition, some mothers are unable to do so because of their own poor health.

This is the third article in a five-part series marking World Breastfeeding Week and the slow uptake in West Africa of this life-saving practice.

In an intensive care nutrition centre run by the NGO Médecins Sans Frontières (MSF) for severely malnourished children in Zinder, the country’s second largest city 900km east of the capital, Nafissa Haboubacar leaned against a wall cradling her two-month old child. “I have no more milk,” said the mother. “I feel sick, but am not sure what I have,” she told IRIN.

Doctors in the unit explained how one of the highest priorities for babies at the centre was to increase their intake of breast milk. The attending MSF doctor, Nicolas Peyraud, told IRIN gastroenteritis diseases are a major child killer. “The mother’s breast milk is a natural vaccine. But unfortunately, not all women are able to breastfeed.”

Haboubacar told IRIN even though she wants to feed her child, she is not sure she can. “Sometimes when I wake up, I do not have breakfast or lunch. So I am not sure from where this milk will come?”

The Ministry of Health focal point for breastfeeding, Karki Roumatou Adamou Arowa, told IRIN even a malnourished mother has a reserve of milk. “But to ensure that the quantity and quality of that milk is sufficient for her child, her health must be restored,” said Arowa.

MSF’s Peyraud told IRIN that the often dehydrated mothers are given food and liquids to increase milk production, while their babies are retrained to suck from their mother’s breasts through feeding tubes closely attached to the nipple that deliver milk formula, thereby stimulating breast milk production.

World Health Organization (WHO) recommends giving newborns only breast milk for their first months of life because of the milk’s natural antibodies and nutrients, but notes that, globally, less than 40 percent of infants aged six months and under are breastfed this way.

In Niger, this figure is less than 5 percent, the government’s Arowa told IRIN. She said that even if women are able to breastfeed exclusively, most feed their babies water in addition to breast milk. “These women do not realize 80 percent of breast milk is water and the other 20 percent, pure nutrients. But yet they say their babies need water to survive.”

Haboubacar at the intensive care centre told IRIN the baby on her lap was her tenth child.

She has lost six of the others.

pt/aj source.www.irinnews.org

Photo: Stop TB Partnership

Medical care in South Africa is worth the trip

HARARE,  – For almost a decade Zimbabwe’s main international bus station, Roadport, in the capital, Harare, has been a bustling hive of people travelling to neighbouring South Africa: informal cross-border traders going to buy goods, others leaving in search of work and a better life. Now they have a new travelling companion – anyone in need of reliable, affordable medical attention.

“I’m going to deliver my first-born child in Pretoria [South Africa] because it is no longer possible to do it here,” said Sophia Chibondo, 25, sitting on a bench next to her anxious husband.

“Being unemployed, and with my husband struggling to keep the family going, we found it wiser to go and seek help from a South African [public] hospital,” she told IRIN. “Maternal costs at local clinics and hospitals are just too much, and we cannot afford them.”

Thousands have fled Zimbabwe’s economic meltdown, food insecurity and political turmoil, but the almost total collapse of the national health system has seen standards plummet and prices rocket, and the Chibondos are now part of a growing group of migrants looking for better, more affordable health care.

South Africa’s Department of Home Affairs (DHA) announced in April 2009 that it would introduce a special dispensation permit allowing Zimbabwean nationals to remain in the country legally for up to 12 months, but this is still being considered by cabinet.

In the meantime, a 90-day ‘visa-free entry’ into South Africa for Zimbabweans is already in effect.

In June 2009 a report by international relief NGO Médecins Sans Frontières (MSF) warned that the adoption of a more “liberal immigration policy” for Zimbabweans was placing greater burdens on South Africa’s already stretched health care system.

“Consultations in our Johannesburg clinic have almost tripled in the last year, a telling sign of the extent to which Zimbabweans are consistently denied access to even the most basic health care services necessary for their survival,” Eric Goemaere, Medical Coordinator at MSF in South Africa, said at the launch of the report.

You often hear of doctors causing the deaths of patients due to negligence. It is therefore not surprising that our patients are avoiding local hospitals

Overpriced and substandard

Private hospitals in Zimbabwe still maintain high standards, but at a premium: a pregnant woman would be expected to fork out well over US3,500 for gynaecologists, paediatricians and anaesthetists, besides money for food, drugs and accommodation for mother and child.

Government health institutions are far cheaper but lack trained staff, drugs and equipment. In South Africa, Chibondo said, she would pay less than US$70 for all the services up to delivery, and she could shop for baby care products and clothes at a fraction of what they cost in Zimbabwe.

“Patients prefer to cross the border [to South Africa] because it is cheaper there, and there are higher levels of care,” said Primrose Matambanadzo, director of the Zimbabwe Association of Doctors for Human Rights (ZADHR).

“People also still don’t have confidence in [Zimbabwean] public health institutions due to the health crisis that … has affected the country for many years,” she commented.

“It is the responsibility of government to ensure a reliable health system, and as long as signs of the crisis linger, Zimbabweans will continue trekking to other countries to get medical attention; a situation that is regrettable.”

Most of Zimbabwe’s public health centres closed last year as employees protested over poor salaries and working conditions during a severe cholera epidemic that began in August 2008 and claimed the lives of more than 4,200 people out of about 100,000 known cases.

Public health facilities reopened in February 2009, when donors made money available for allowances that brought striking nurses and doctors back to work.

Health minister Paul Madzore recently admitted that a lot needed to be done to kick-start a health system severely affected by the migration of thousands of doctors, nurses and other skilled personnel.

“You often hear of doctors causing the deaths of patients due to negligence. It is therefore not surprising that our patients are avoiding local hospitals,” said Matambanadzo.

Chibondo had visited the facility where she would be having her baby several times for prenatal examinations. “I am encouraged by the quality of service at the hospital and the professionalism of the staff – rare things to find in Zimbabwe,” she said. Her elder sister had also given birth there.

fm/tdm/he source.www.irinnews.org

GUINEA-BISSAU: “It’s like a hotel for pregnant women”

Photo: Felicity Thompson/IRIN

Kadiatou Barry (right) relaxes at the House of Mothers, a residential facility in the remote region of Gabu

BISSAU, – One in 13 women in Guinea-Bissau dies from complications during pregnancy – one of the highest death rates in the world, according to the UN Children’s Fund (UNICEF).

Kadiatou Barry, 21, pregnant for the first time, is seeking treatment at the government health centre in Gabu, a remote town 200km northeast of the capital, Bissau. The doctor says she has high blood pressure and anaemia, putting both mother and baby at risk.

But Barry may overcome these odds – she is one of more than 800 pregnant women referred over the past three years to the House of Mothers, a residential facility set up in Gabu’s health centre for women at risk of complications during pregnancy.

The House of Mothers is part of a wider project, Maternity without Risks, run by NGO Catholic Relief Services (CRS) with Guinea-Bissau’s Ministry of Health and the Catholic NGO network, Caritas. The project aims to reduce Guinea-Bissau’s infant and maternal death levels by having at-risk mothers cared for as early as possible before potentially life-threatening complications set in, according to project coordinator Serifo Embalo.

Regular check-ups and relatively straightforward interventions, such as providing treated bed nets and iron-fortified food, can keep mothers alive, says UNICEF.

But most mothers in Guinea-Bissau die because complications are diagnosed too late, said Guy de Araújo, Bissau-based representative of the UN Population Fund (UNFPA).

Photo: Felicity Thompson/IRIN

Idiatou Sadjo Diallo, 26, has already lost her first two babies. Pregnant with her third child, she is now being cared for at the House of Mothers

Early referral

Two-thirds of women in Guinea-Bissau give birth at home and do not regularly visit health centres until their problems are too far gone, says UNFPA.

Capacity for early referrals is still very low, given insufficient health-workers in rural areas, and the lack of free, efficient transport to health centres, according to government health adviser Antonieta Martins.

Maternity without Risks also runs a mobile clinic touring 16 villages to give pregnant women free consultations and train community volunteers to identify at-risk mothers for referral early on.

One of the most common problems is pregnancy complications caused by chronic malnutrition and resulting anaemia, according to UNICEF, which can lead to haemorrhaging.

“Think about a young girl who has been chronically malnourished. That means she is small, she has difficulties in pregnancy, she is anaemic. So she can easily die of haemorrhage,” says Silvia Luciani, UNICEF’s Guinea-Bissau representative.

At the centre, women receive three balanced meals a day, regular medical supervision and birthing kits. “It’s like a hotel for pregnant women,” Embalo said. “The sanitary conditions for giving birth in the village are not good. At the House of Mothers, everything is kept clean and sterile and each woman has her own bed with a treated mosquito net.”

Barry said she was enjoying her pregnancy at the centre: “You get a lot of support here.”

Together with its sister centre 50km away in Bafata, the House of Mothers aims to treat 2,000 women per year. When the centres are full, women are sent to Gabu hospital, which in June 2009 opened a surgical unit with help from UNFPA and the Portuguese government.

Survival rates improving

Provisional data already show higher survival rates in Gabu and Bafata among women who come from the House of Mothers compared with those who do not, Mawo Fall, CRS health project manager for Guinea-Bissau, told IRIN.

“The other women come very late,” said Gabriel Minkibam, head of Gabu region’s sole maternity ward. “They have had no supervision over the nine months of their pregnancy, so they arrive with too many complications. They are the ones who lose their babies.”

But at the government hospital essential medicines to induce labour, and equipment to perform emergency operations, such as caesarean sections, are still in short supply, he said. He pointed to a woman on a cot: “This girl may need an intervention, but I have no caesarean kits available.”

In the next room four women lay on cots, listless and staring into space. All of them arrived at the health centre with highly-advanced complications and three have just lost their babies.

At the House of Mothers, Idiatou Sadjo Diallo, 26, pregnant with her third baby, has high hopes. “I lost my first two babies. The first one I had an abortion and the second time I gave birth in the hospital but the baby came out dead. With this third baby I am worried, but I hope this time the birth will go well.”

ft/aj/mw source.irinnews.org

In Summary