Published on January 17, 2008
Ensuring Effective Caring Practices within Families and Communities: Ensuring Effective Caring Practices within Families and Communities Isatou Jallow Executive Director National Nutrition Agency (NaNA) The Gambia Overview of Presentation: Overview of Presentation Background on care, caring practices, indicators The situation of women and children How do we ensure effective caring practices within families and communities? The way forward How important is Care in the African context?: How important is Care in the African context? An African Regional Nutrition Strategy (1993-2003) adopted by the then OAU African Council of Ministers at their 58th session in 1993 cited inadequate care as an important factor in the poor nutritional status of women and children in Africa. This according to the strategy, was due to the disappearance of the traditional African extended system. Defining Care and Caring Practices: Defining Care and Caring Practices “Behaviours and practices of caregivers to provide the food, health care, stimulation and emotional support necessary for children’s healthy growth and development” 3 categories of Care: Nutritional, Psychosocial and Physical Breastfeeding = Foundation for Care: Breastfeeding = Foundation for Care Breastfeeding the act combined with breastmilk the product cuts across all the categories of care Examples of caring practicesin all three categories: Examples of caring practices in all three categories Breastfeeding Providing emotional security Reducing the child’s stress Providing shelter and clothing Feeding, bathing supervision of child’s toilet Preventing and attending to illness Nurturing and showing affection Interaction and stimulation Playing and socialising Protecting from exposure to pathogens providing a relatively safe environment for exploration Child Development: Child Development Multi-dimensional and inter-dependent Social, emotional, cognitive and motor performance Patterns of behaviour Health and nutritional status Child Development : Child Development Early years (first 3) critical foundation for healthy psychosocial development - intelligence, personality and social behaviour Brain development <1year is rapid and extensive and is vulnerable to environmental influence – nutrition, health, care and stimulation. Child Development: Child Development Early stimulation such as talking, singing to the child makes the child more responsive A child’s capacity for mental and social development depends on biological systems shaped by early experience and attachment Studies show that children who have secure attachments early in life, function better in society and perform better in school Stimulating a child is like motivating a worker – the output is greater Nutrition Security and Early Childhood Development: Nutrition Security and Early Childhood Development Nutrition Security – Food security coupled with a sanitary environment, adequate health services and knowledgeable care to foster good nutritional status through the life cycle and across generations Food; Health; Care; Safe Environment Early Childhood development – an integrated approach that promotes a holistic view of the chid and a coordination of activities in the five priority areas – health, water, hygiene and sanitation, nutrition, early stimulation/education and protection Slide11: UNICEF conceptual framework of the determinants of nutritional status (IFPRI/Benson 2004) Women Produce, Reproduce, Nurture, and Care : Women Produce, Reproduce, Nurture, and Care Care for the Caregiver: Care for the Caregiver “Mothers and babies form an inseparable biological and social unit; the health and nutrition of one group cannot be divorced from the health and nutrition of the other” (Resolution WHA55.25 on Infant and Young Child Nutrition). Caring practices: Caring practices Family planning services – contraceptive use Ante-natal care Skilled attendance at birth Post-natal care Maternity protection laws Education Reducing workload during pregnancy and lactation Reducing the mother’s stress Showing care and affection for the mother Indicators of Care for Women and Children: Indicators of Care for Women and Children Child Mortality Rates Nutritional status – underweight, stunting, wasting Exclusive breastfeeding rates Complementary feeding Immunisation coverage Use of insecticide treated nets Provision of clean water and adequate sanitation Maternal mortality rates Low Birth Weight Family planning services – use of contraceptives Micro-nutrient deficiencies Proportion of household utilising Iodised salt Vitamin A supplementation coverage Skilled attendance at birth Proportion of children attending early childhood centres The situation of Women and Children: The situation of Women and Children 10.8 million children die each year in the developing world 41% of child deaths from Sub-Saharan Africa Risk factors include unhygienic environment, unsafe and inadequate water, poor sanitation and undernutrition as an underlying factor Maternal mortality estimated at 940 per 100,000 for sub-Saharan African (UNICEF SOWC 2005). Women and Children: Women and Children 14 out of 18 countries with Neonatal Mortality Rates of >44 per 1000 are from Sub-Saharan Africa Countries in conflict situations register the highest rates Maternal Health and health care are important determinants of neonatal survival Child Mortality Rates and Nutrition status in Africa (0 – 5 years): Child Mortality Rates and Nutrition status in Africa (0 – 5 years) Women and Children: Women and Children Infant feeding practices – exclusive breastfeeding rates infants <6months 28% for SSA, 50% of children between 20-23 months still breastfeeding Utilisation of preventive health services e.g. immunisation of children less than desired Female literacy levels low but progress in some countries Foetal Nutritional status – proxy indicator of maternal nutritional status: Foetal Nutritional status – proxy indicator of maternal nutritional status Huffman, et al., 2000 The Burden of Malnutrition: The Burden of Malnutrition Haunts you through your whole life - Impacts the next generation Challenges to effective caring practices : Challenges to effective caring practices Economic/Political High poverty levels and several countries in conflict situations, governments unable to provide basic public services Health Services/Disease burden HIV/AIDS, Malaria, Micronutrient deficiencies Challenges: Challenges Sub-Saharan Africa with highest HIV/AIDs prevalence figures Africa with highest fertility risks in the world “too frequent + too soon – early marriages SSA with 30% of world’s Maternal deaths Low access in many countries to clean water and sanitation – rural/urban disparities Low maternal literacy levels Family & Community 12 Practices for Child Survival, Growth, Development (WHO, 2004): Family & Community 12 Practices for Child Survival, Growth, Development (WHO, 2004) Immunisation Breastfeeding Complementary feeding Micronutrients Hygiene Treated Bed nets Foods and fluids during illness Home treatment Care seeking Adherence Stimulation Antenatal care Ensuring effective Caring practices within families and communities – Who is responsible?: Ensuring effective Caring practices within families and communities – Who is responsible? Stakeholders at different levels of society Actions at different levels of society Stakeholders and Actions complement each other Linking Stakeholders and Actions: Linking Stakeholders and Actions Macro – Meso - Micro Actions: Macro – Meso - Micro Actions Government Polices – maternity protection laws; food fortification laws, National Code of marketing of breastmilk substitutes Service delivery level – immunisation, vitamin A and iron supplementation, nutrition and health education Community/Household level – visits to service delivery centres for care, brestfeeding, hygienic practices Care-giving across generations – Grandmothers and Siblings – singing, dancing, feeding, comforting: Care-giving across generations – Grandmothers and Siblings – singing, dancing, feeding, comforting Fathers as caregivers – time to document fathers’ contribution: Fathers as caregivers – time to document fathers’ contribution Can fathers be encouraged to take a more active role in care-giving? Father’s contribution to care-giving – is it being underestimated? Fathers smoking away from their families – a caring practice? Ensuring effective caring practices within families and communities – An example from The Gambia: Ensuring effective caring practices within families and communities – An example from The Gambia The Baby Friendly Community Initiative - Promoting Exclusive breastfeeding Building on Traditional and local knowledge, beliefs and practices e.g. communities’ local knowledge of young animals being breastfed exclusively for a period of time and surviving Traditional shelters at the fields to enable lactating mothers take their infants to the fields Involvement of men in all aspects of the intervention Supporting communities to create an enabling environment Village Support Group on Infant Feeding: Village Support Group on Infant Feeding Baby Friendly Rest House at the Fields: Baby Friendly Rest House at the Fields Local communities disseminating messages through songs and dances on maternal/infant nutrition, environmental sanitation/personal hygiene : Local communities disseminating messages through songs and dances on maternal/infant nutrition, environmental sanitation/personal hygiene The Lancet Child Survival Series(caring practices)Interventions to reduce Child Mortality Rates: The Lancet Child Survival Series (caring practices) Interventions to reduce Child Mortality Rates Preventive Treatment Breastfeeding 13% Insecticide Treated Nets 7% Complementary Feeding 6% Clean delivery 4% Water/sanitation/hygiene 3% Vitamin A 2% Tetanus Toxoid 2% Newborn temperature management 2% Measles vaccine 1% Treatment Intervention Oral rehydration therapy (ORT) 15% Antibiotics for sepsis 6% Antibiotics for pneumonia 6% Antimalarials 5% Newborn resuscitation 4% Antibiotics for dysentry 3% The Way forward - Questions to ask: : The Way forward - Questions to ask: How can we achieve universal coverage with these interventions? What local skills and knowledge do families have on ECD and care for mothers and their children? What additional skills and knowledge do they need to improve current caring practices? How can local knowledge and skills be used positively to enhance caring practices? How can local practices that ensure psychosocial stimulation of children be documented and promoted? What is the situation of care for the girl child? Do communities and families recognise the vulnerability of the adolescent girl? Educating the girl child – is it recognised as a caring practice by communities and families? Questions to ask:: Questions to ask: Care and Support for women during pregnancy and lactation – how can men be supported to take an active role? What child caring activities can men participate in? What is the role of the traditional media in promoting effective caring practices? How are international rights instruments understood at the local level – within families and communities? How can we ensure that governments reporting on the CRC include indicators pertaining to caring practices and Early Childhood Development? The Vulnerable among the Vulnerable – women and children living with HIV/AIDS and or living in conflict situations – how do communities and families cope – what resources do they require to ensure adequate care? Millennium Development Goals, Care and ECD: Millennium Development Goals, Care and ECD Reduce extreme hunger and poverty Achieve universal primary school education Promote Gender equality and empower women Reduce Child mortality Improve maternal health Combat HIV/AIDS, malaria and other diseases Slide39: Care-Nutrition-Early Childhood Development-Socio-Economic Development “No Nation can afford to waste its greatest national resource, the intellectual power of its people. But that is precisely what is happening where low birth weight is common, where children fail to achieve their full potential growth, where micro-nutrient deficiencies permanently damage the brain, and where anaemia and short- term hunger limit children’s perform- ance at school.” (Nutrition: Foundation for Development UN SCN, 2000, Geneva)
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